An analysis on the adjuvant efficacy of intravenous or perineural administered dexamethasone in erector spina plane block applied to patients who had thoracotomy: a prospective randomized double-blind study

Year 2022, , 13 - 18, 24.01.2022

Tuna Ertürk , Bülent Barış Güven , Aysin Ersoy

https://doi.org/10.38053/acmj.1013842

Abstract

Aim: Thoracic surgery is one of the surgical procedures that necessitates effective pain management both before and after the procedure. Because of the adverse effects of opioids in thoracic surgeries, regional anesthesia has been widely used for postoperative analgesia. One of the most recent techniques used with this indication is erector spina plane block (ESPB). Many studies in regional anesthesia have shown that adding dexamethasone to local anesthetics as an adjuvant agent prolongs the analgesic effect. The purpose of the present study was to assess the effect of dexamethasone, which is used as a perineural and intravenous adjuvant, on the duration and level of analgesia of ESPB used in thoracic surgeries.
Material and Method: This prospective, randomized controlled study included 60 patients who would have a thoracotomy under general anesthesia and ESP for peri-operative analgesia. Patients were divided into three groups: those who received perineural dexamethasone (Group PN), those who received IV dexamethasone (Group IV), and those who did not receive any dexamethasone at all (Group C-Control). Numerical rating scale (NRS) scores, rescue analgesic drug use and block times were recorded at the postoperative 2nd, 6th, 12th, 24th and 36th hours.
Results: There was no statistically significant (p>0.05) difference in blocking times or additional analgesic use between the three groups. There was no statistically significant (p>0.05) difference in the NRS scores when the patients’ pain levels were measured in all three groups. 36th hour NRS scores and additional analgesic use were higher in the group that did not receive IV or perineural dexamethasone.
Conclusion: NRS scores and rescue analgesic use were similar between ESPB groups with intravenous or perineural addition of 4 mg dexamethasone and ESPB group administered without dexamethasone. However, the NRS score average in the group C was greater than 3, particularly in the 36th hour NRS data, whereas the NRS scores in the group PN and group IV were less than 2.

Keywords

Erector spina plane block, perineural dexamethasone, intravenous dexamethasone, thoracotomy, postoperative analgesia

Project Number

Yok

References

• Homma T, Doki Y, Yamamoto Y, et al. Risk factors of neuropathic pain after thoracic surgery. J Thorac Dis 2018; 10: 2898–907.
• Xie C, Ran G, Chen D, Lu Y. A narrative review of ultrasound-guided serratus anterior plane block. Ann Palliat Med 2021; 10: 700-6.
• Pirsaharkhiz N, Comolli K, Fujiwara W, et al. Utility of erector spinae plane block in thoracic surgery. J Cardiothorac Surg 2020; 15: 1-6.
• Romero A, Garcia JEL, Joshi GP. The state of the art in preventing postthoracotomy pain. Semin Thorac Cardiovasc Surg 2013; 25: 116–24.
• Moustafa MA, Alabd AS, Ahmed AMM, Deghidy EA. Erector spinae versus paravertebral plane blocks in modified radical mastectomy: Randomised comparative study of the technique success rate among novice anaesthesiologists. Indian J Anaesth 2020; 64: 49–54.
• Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector Spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016; 41: 621–7.
• Hewson D, Bedforth N, McCartney C, Hardman J. Dexamethasone and peripheral nerve blocks: back to basic (science). Br J Anaesth 2019; 122: 411-2.
• Mchardy PG, Singer O, Awad IT, et al. Comparison of the effects of perineural or intravenous dexamethasone on low volume interscalene brachial plexus block: a randomised equivalence trial. Br J Anaesth 2020; 124: 84-91.
• Goto T. What is the best pain control after thoracic surgery? J Thorac Dis 2018; 10: 1335-8.
• Cassi LC, Biffoli F, Francesconi D, Petrella G, Buonomo O. Anesthesia and analgesia in breast surgery: the benefits of peripheral nerve block. Eur Rev Med Pharmacol Sci 2017; 21: 1341–5.
• Szewczyk J, Nguyen BH, Villamizar N, Nguyen DM. Achieving pain control with opioid-sparing multimodal analgesic strategy–doing more with less by enhanced recovery after thoracic surgery protocol: A Review. J Anesthesiol Pain Ther 2020, 1.3.
• Wenk M, Schug SA. Perioperative pain management after thoracotomy. Curr Opin Anaesthesiol 2011; 24: 8-12.
• Niesen AD, Jacob AK, Law LA, Sviggum HP, Johnson RL. Reg Anesth Pain Med 2020; 45: 813-7.
• Seelam S, Nair AS, Christopher, Upputuri O, Naik V, Rayani BK. Efficacy of single-shot ultrasound-guided erector spinae plane block for postoperative analgesia after mastectomy: a randomized controlled study. Saudi J Anaesth 2020; 14: 22-7.
• Gürkan Y, Aksu C, Kus A, Yörükoğlu UH. Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: a randomized controlled trial. J Clin Anesth 2020; 59: 84-8.
• Peker K, Peker SA. The effect of erector spinae plane block on cost of percutaneous nephrolithotomy surgery. J Health Sci Med 2020; 3: 409-14
• Axelsson K, Gupta A. Local anaesthetic adjuvants: neuraxial versus peripheral nerve block. Curr Opin Anaesthesiol 2009; 22: 649–54.
• Baeriswyl M, Kirkham KR, Jacot-Guillarmod A, Albrecht E. Efficacy of perineural vs systemic dexamethasone to prolong analgesia after peripheral nerve block: a systematic review and meta-analysis. Br J Anaesth 2017; 1; 119: 183-91.
• Oğurel T, Örnek K, Oğurel R, Onaran Z. The effect of intracameral dexamethasone used at the end of cataract surgery on macular edema in eyes with diabetic retinopathy. J Health Sci Med 2019; 2: 18-23
• Watkins TW, Dupre S, Coucher JR. Ropivacaine and dexamethasone: a potentially dangerous combination for therapeutic pain injections. J Med Imaging Radiat Oncol 2015; 59: 571–7
• Desmet M, Vanneste B, Reynvoet M, et al. A randomised controlled trial of intravenous dexamethasone combined with interscalene brachial plexus blockade for shoulder surgery. Anaesthesia 2015; 70: 1180–5.
• Albrecht E, Kern C, Kirkham KR. Perineural vs intravenous administration of dexamethasone: more data are available. Br J Anaesth 2015; 114: 160.
• Desmet M, Braems H, Reynvoet M, et al. I.V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery: a prospective, randomized, placebocontrolled study. Br J Anaesth 2013; 111: 445–52.
• Kawanishi R, Yamamoto K, Tobetto Y, et al. Perineural but not systemic low-dose dexamethasone prolongs the duration of interscalene block with ropivacaine: a prospective randomized trial. Local Reg Anesth 2014; 7: 5–9.
• Leurcharusmee P, Aliste J, Van Zundert TC, et al. A multicenter randomized comparison between intravenous and perineural dexamethasone for ultrasound-guided infraclavicular block. Reg Anesth Pain Med 2016; 41: 328–33.
• Aliste J, Leurcharusmee P, Engsusophon P, et al. A randomized comparison between intravenous and perineural dexamethasone for ultrasound-guided axillary block. Can J Anaesth 2017; 64: 29-36.
• Holland D, Amadeo RJJ, Wolfe S, et al. Effect of dexamethasone dose and route on the duration of interscalene brachial plexus block for outpatient arthroscopic shoulder surgery: a randomized controlled trial. Can J Anaesth 2018; 65: 34-45.
• Kahn RL, Cheng J, Gadulov Y, Fields KG, YaDeau JT, Gulotta LV. Perineural low-dose dexamethasone prolongs interscalene block analgesia with bupivacaine compared with systemic dexamethasone: a randomized trial. Reg Anesth Pain Med 2018; 43: 572-9.
• Fu J, Zhang G, Qiu Y. Erector spinae plane block for postoperative pain and recovery in hepatectomy: A randomized controlled trial. Medicine 2020; 99: e22251.
• Mostafa SF, Abdelghany MS, Abu Elyazed MM. Ultrasound‐guided erector spinae plane block in patients undergoing laparoscopic bariatric surgery: a prospective randomized controlled trial. Pain Pract 2021; 21: 445-53.
• Luo R, Tong X, Yan W, Liu H, Yang L, Zuo Y. Effects of erector spinae plane block on postoperative pain in children undergoing surgery: A systematic review and meta‐analysis of randomized controlled trials. Pediatric Anesthesia, 2021, 31: 1046-55.
• Herman JA, Urits I, Kaye AD, Urman RD, Viswanath O. Erector Spinae Plane Block (ESPB) or Quadratus Lumborum Block (QLB-II) for laparoscopic cholecystectomy: Impact on postoperative analgesia. J Clin Anesth 2020; 66: 109958.