Ultrasound-guided erector spinae block for postoperative analgesia in thoracotomy patients: a prospective, randomized, observer-blind, controlled clinical trial

Background and objectives

Thoracotomy is considered the most painful of surgical procedures and providing adequate analgesia is the onus for all anaesthesiologists. This study investigated the efficacy of the ultrasound-guided erector spinae plane (ESP) block in analgesia after thoracotomies.

Patients and methods

Sixty patients with American Society of Anesthesiology physical status (ASA-PS) I–IV, aged more than 18 years were allocated to two groups, ESP group which received the ESP block and C (control) group with no block. Single-shot U/S-guided ESP block with 20 ml 0.25% bupivacaine at the 5th thoracic vertebral level was performed preoperatively in the ESP group. Postoperative 24 h morphine consumption and pain scores were compared between the groups. Also, the side effects of opioid usage were compared.

Main results

Postoperative morphine consumption was 22.06 ± 6.24 mg in the ESP group and 30.6 ± 6.23 mg in the C group (p < 0.001). Results showed that there was a significant difference between both groups in favour of the ESP group regarding visual analogue score (VAS) at rest and with coughing (p < 0.001).

Conclusion

Our study findings show that US-guided ESP block exhibits a significant analgesic effect in patients undergoing thoracotomy surgery.

Trial registration

ClinicalTrials.gov, NCT03749395. Registered 13 November 2018

Effect of intranasal dexmedetomidine on emergence agitation after sevoflurane anesthesia in children undergoing tonsillectomy and/or adenoidectomy

BACKGROUND

Emergence agitation (EA) after sevoflurane anesthesia is common in children during recovery from general anesthesia and may result in postoperative complications. This study investigated safety and effectiveness of intranasal dexmedetomidine in reducing the incidence and severity of EA.

METHODS

This prospective, randomized double-blinded controlled trial included 86 patients scheduled for the tonsillectomy and/or adenoidectomy under general anesthesia with sevoflurane. They were randomly allocated into two groups. Group D received intranasal dexmedetomidine at 1 μg/kg, and Group C received intranasal saline 0.9% after the induction of general anesthesia. Four-point agitation scale and Face, Legs, Activity, Cry and Consolability (FLACC) scale for pain assessment were measured at six time points (after extubation, leaving the operating room, on arrival to postanesthesia care unit [PACU], 10, 20, and 30 min after arrival in PACU). Extubation, emergence, and discharge times were recorded in addition to any adverse effects.

RESULTS

There was a significant difference in the incidence of EA between Groups D and C (6.98% and 58%, respectively, with P = 0.001). The median four-point agitation scales and the median scores of FLACC pain scales of Group D were significantly lower than those of Group C at the all six time points with P < 0.05. Extubation, emergence, and discharge times were comparable in both groups, and none of the subjects reported any adverse effects.

CONCLUSION

This study demonstrates that a 1 μg/kg dose of intranasal dexmedetomidine administered after the induction of anesthesia reduces post-sevoflurane incidence and severity of EA in children undergone tonsillectomy and/or adenoidectomy with no adverse effects and smooth recovery profile.