Levobupivacaine versus Levobupivacaine-Dexmedetomidine in Thoracic Paravertebral Block for Laparoscopic Sympathectomy.

Autor: Adel Elmaddawy AE; Department of Anesthesia, Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt., Diab DG; Department of Anesthesia, Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt., Farag MA; Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Jazyk: angličtina
Zdroj: Anesthesia, essays and researches [Anesth Essays Res] 2018 Oct-Dec; Vol. 12 (4), pp. 837-842.
DOI: 10.4103/aer.AER_126_18
Abstrakt: Background: Thoracic paravertebral block (TPVB) is a high-quality analgesic technique used for many types of surgery, trauma, and chronic pain.
Aim: The aim of this study is to assess safety and efficacy of adding dexmedetomidine to levobupivacaine in TPVB for postoperative analgesia after unilateral laparoscopic thoracic sympathectomy.
Patients and Methods: Sixty adult patients of the American Society of Anesthesiologists physical status classes I and II, aged 20-45 years, of either sex, submitted for unilateral laparoscopic thoracic sympathectomy under general anesthesia at Mansoura University Hospital. Patients were classified into two groups such as levobupivacaine (G L ): patients received isobaric 0.5% levobupivacaine 1 mg/kg in 20-ml volume for TPVB and levobupivacaine-dexmedetomidine (G LD ): patients received isobaric 0.5% levobupivacaine 1 mg/kg and 10-μg dexmedetomidine in 20 ml volume for TPVB.
Statistical Analysis: Data were first tested for normality by Kolmogorov-Smirnov test. Normally distributed continuous data were analyzed using unpaired Student's t -test. Nonnormally distributed continuous and ordinal data were analyzed using Mann-Whitney U-test. Categorical data were analyzed by Chi-square test or Fisher's exact test as appropriate.
Results: A faster onset and longer duration of sensory blockade was significantly higher in group G LD with mean ± standard deviation (SD) (8.57 ± 7.22 min and 11.98 ± 1.42 h) than in group G L (15.21 ± 4.35 min and 9.75 ± 3.29 h). Sensory block regression time was significantly longer in group G LD with mean ± SD (10.8 ± 2.31 h) compared to group G L (8.82 ± 1.71 h). Furthermore, a significant reduction in visual analog scale occurred in group G LD compared with the G L group up to 24 h postoperatively ( P < 0.05). No significant difference in Ramsay Sedation Scale (RSS) between both groups. The number of patients asked for postoperative analgesia was significantly fewer in group G LD compared with group G L (14 compared to 21)*. The time (hours) of first request for analgesia was significantly longer in group G LD compared with G L group (7.8 ± 3.22 compared to 9.7 ± 2.51*). The total postoperative fentanyl requirements in 24 h (in micrograms) was significantly less in G LD group compared to G L group (320 ± 110 compared to 190 ± 120*).
Conclusion: The addition of dexmedetomidine as adjuvant to levobupivacaine in TPVB for elective unilateral laparoscopic thoracic sympathectomy can markedly improve the postoperative analgesia with lower pain scores and a marked reduction of the postoperative analgesic requirements and low side effect profile.
Competing Interests: There are no conflicts of interest.
Databáze: MEDLINE
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