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

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.