Effect of Dexmedetomidine Versus Dexamethasone as Adjuvant to Bupivacaine in Ultrasound Guided Erector Spinae Plane Block on Postoperative Analgesia in Myasthenic Patients Undergoing Thoracoscopic Thymectomy

This current comparative study involved 54 patients undergoing thoracoscopic thymectomy who were distributed randomly into three equal groups to receive ultrasound (US)-guided ESPB using 20 ml bupivacaine 0.25% (group B) , 20 ml bupivacaine 0.25% with 8 mg dexamethasone (group BS), 20 ml bupivacaine 0.25% with dexmedetomidine 1mcg/kg (group BM). The time till the first postoperative rescue analgesic requested was the primary outcome. The secondary outcomes included the postoperative pain scores and analgesic consumption.

Study Overview

• Status: Not yet recruiting
• Conditions: Postoperative Pain, Acute
• Intervention / Treatment: Procedure: Erector Spinae Plane Block

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ramy Mahrose; Phone Number: 01281431097; Email: Ramy.ahmed@med.asu.edu.eg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• myasthenic patients
• American Society of Anesthesiologists (ASA) physical grade of 2-3)
• who underwent video assisted thoracoscopic thymectomy

Exclusion Criteria:

• Refused participation in the study,
• known allergy for this study drugs ,
• Contraindication to the ESPB as infection at block site & marked chest cage deformity,
• significant bleeding disorders ,
• patients with significant renal or liver dysfunction,
• heart block ,
• poor ventilatory function,
• severe chronic obstructive pulmonary disease,
• morbid obesity,
• mental disability, or communication difficulties that hindered effective pain assessment,
• Individuals who was converted to open thoracotomy or those re-explorated for surgical related issues.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: (group B); ultrasound (US)-guided ESPB using 20 ml bupivacaine 0.25%	Procedure: Erector Spinae Plane Block; An echogenic 21 gauge 10 cm needle was introduced in caudo-cephalic orientation utilizing the in-plane approach and traversing through trapezius, rhomboid, and erector spinae muscles till reaching the transverse process then slightly withdrawn and hydrodissection was done by 3 mL of saline 0.9% to verify the accurate implantation of the block needle tip between the erector spinae muscle and the transverse process (the erector spinae plane). Incremental LA injection was verified through US observation for the upward displacement and lifting of erector spinae muscle from the transverse process with craniocaudal spread of the LA in the targeted plane. The LA increments were one ml every 5 seconds with intermittent aspiration every 5 mL to avoid intravascular injection.
Active Comparator: Group BS; 20 ml bupivacaine 0.25% with 8 mg dexamethasone	Procedure: Erector Spinae Plane Block; An echogenic 21 gauge 10 cm needle was introduced in caudo-cephalic orientation utilizing the in-plane approach and traversing through trapezius, rhomboid, and erector spinae muscles till reaching the transverse process then slightly withdrawn and hydrodissection was done by 3 mL of saline 0.9% to verify the accurate implantation of the block needle tip between the erector spinae muscle and the transverse process (the erector spinae plane). Incremental LA injection was verified through US observation for the upward displacement and lifting of erector spinae muscle from the transverse process with craniocaudal spread of the LA in the targeted plane. The LA increments were one ml every 5 seconds with intermittent aspiration every 5 mL to avoid intravascular injection.
Active Comparator: Group BM; 20 ml bupivacaine 0.25% with dexmedetomidine 1mcg/kg	Procedure: Erector Spinae Plane Block; An echogenic 21 gauge 10 cm needle was introduced in caudo-cephalic orientation utilizing the in-plane approach and traversing through trapezius, rhomboid, and erector spinae muscles till reaching the transverse process then slightly withdrawn and hydrodissection was done by 3 mL of saline 0.9% to verify the accurate implantation of the block needle tip between the erector spinae muscle and the transverse process (the erector spinae plane). Incremental LA injection was verified through US observation for the upward displacement and lifting of erector spinae muscle from the transverse process with craniocaudal spread of the LA in the targeted plane. The LA increments were one ml every 5 seconds with intermittent aspiration every 5 mL to avoid intravascular injection.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
the duration between the surgery end and the 1st rescue analgesia the patient requested.	24 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Time Frame
.Total ketorolac consumption	24 hours postoperatively
. Number of patients needed rescue tramadol	24 hours postoperatively

Collaborators and Investigators

• Sponsor: Ain Shams University

Study record dates

Study Major Dates

• Study Start (Estimated): March 15, 2026
• Primary Completion (Estimated): September 15, 2026
• Study Completion (Estimated): September 15, 2026

Study Registration Dates

• First Submitted: February 15, 2026
• First Submitted That Met QC Criteria: February 15, 2026
• First Posted (Actual): February 20, 2026

Study Record Updates

• Last Update Posted (Actual): February 20, 2026
• Last Update Submitted That Met QC Criteria: February 15, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative
• Other Study ID Numbers: HRM 3

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No