Paravertebral Dexmedetomidine in Video-Assisted Thoracic Surgeries for Acute and Chronic Pain Prevention.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) is considered as one of the minimally invasive surgeries. Early postoperative pain alleviation is very important to avoid complications, at the same time, proper early pain control is an established fact to decrease the incidence of chronic pain. OBJECTIVES: To evaluate the efficacy of thoracic paravertebral block (PVB) by a bupivacaine/ dexmedetomidine mixture on acute and chronic post-thoracoscopic surgery pain in patients undergoing VATS. STUDY DESIGN: A randomized prospective double-blinded trial. SETTING: Assiut University Hospitals, Orman Cardiology Hospital. METHODS: Sixty adult patients underwent elective VATS surgery under general anesthesia randomly allocated into 2 groups; Group I received thoracic PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and Group II received PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and dexmedetomidine (1 mcg/kg). Postoperative pain (at rest, with cough, and with movement) was assessed through a visual analog scale (VAS) every 30 minutes in the first 2 hours, then at the second, fourth, eighth, and 24th hours. Time to first analgesia request and consumption of intravenous rescue analgesia (ketorolac tromethamine 30 mg/dose) was recorded. Follow-up of the patients regarding the incidence of chronic post-thoracoscopic pain by the end of the third and sixth months after the procedure was reviewed through the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale. RESULTS: VAS score was significantly lower in Group II during the early postoperative 90 minute records. Pain with cough and with movement persisted to be significantly lower in Group II up to the second postoperative hour. Time to first analgesia requirement was significantly longer in Group II in comparison to Group (P < 0.001). There was less ketorolac consumption in Group II than in Group I (P = 0.002). At the third month, Group II showed significantly lower incidence of LANSS pain scale than Group I (P = 0.04). LIMITATIONS: There was the heterogeneity of surgical procedures in the patients. CONCLUSIONS: Dexmedetomidine as an adjuvant to bupivacaine PVB offers better pain relief during the early postoperative hours, and it carries a favorable effect on chronic postoperative pain.Clinical trial registry number: NCT03632161. KEY WORDS: Dexmedetomidine, paravertebral block, video-assisted thoracoscopic surgery, postoperative pain, chronic pain.

Using fentanyl and propofol for tracheal intubation during sevoflurane induction without muscle relaxants in children: A randomized prospective study.

CONTEXT: Tracheal intubation is frequently facilitated with sevoflurane induction without the use of muscle relaxants in children. AIM: The aim of this study was to compare the effects of two different doses of propofol preceded by a fixed dose of fentanyl during sevoflurane induction on quality of tracheal intubation in children. SETTINGS AND DESIGN: This was a prospective randomized study. SUBJECTS AND METHODS: Ninety American Society of Anesthesiologists I-II children aged 2-6 years were randomly assigned to one of two equal groups to receive 2 µg/kg of fentanyl with 2 mg/kg of propofol (Group I) or 2 µg/kg of fentanyl with 3 mg/kg of propofol (Group II) during sevoflurane induction. The intubating conditions and hemodynamic responses were evaluated. The time from sevoflurane induction to loss of consciousness, to intravenous line insertion, and to intubation was measured. The occurrence of any adverse effect was recorded. STATISTICAL ANALYSIS USED: Results were analyzed using Student's t-test, paired t-test, and Chi-square test. P < 0.05 was considered statistically significant. RESULTS: The incidence of excellent intubating conditions was achieved more significantly in Group II (41/45 patients, 91%) than that in Group I (31/45 patients, 69%) (P = 0.008) (95% confidence interval [CI] =0.39-0.8). Whereas, there were no significant differences between the two groups in terms of the overall acceptable intubating conditions in Group I (40/45 patients, 89%) and Group II (43/45 patients, 96%) (P = 0.81) (95% CI = 0.71-1.31). No patient developed any adverse effect. CONCLUSION: The administration of 3 mg/kg propofol preceded by 2 µg/kg fentanyl provided a higher proportion of excellent intubating conditions compared with 2 mg/kg propofol preceded by 2 µg/kg fentanyl during sevoflurane induction in children without muscle relaxants.