Efficacy of perineural dexamethasone with ropivacaine in thoracic paravertebral block for postoperative analgesia in elective thoracotomy: a randomized, double-blind, placebo-controlled trial

Yu Mao, Youmei Zuo, Bin Mei, Lijian Chen, Xuesheng Liu, Zhi Zhang, Erwei Gu, Yu Mao, Youmei Zuo, Bin Mei, Lijian Chen, Xuesheng Liu, Zhi Zhang, Erwei Gu

Abstract

Purpose: The purpose of this study was to assess the efficacy of perineural dexamethasone with ropivacaine in multimodal analgesia for thoracic paravertebral block (TPVB) in patients undergoing elective thoracotomy.

Patients and methods: Ninety-six patients undergoing thoracotomy were enrolled in this trial and randomized to adjuvant therapy for TPVB: group S (saline), group R (0.5% ropivacaine), or group RD (5 mg dexamethasone and 0.5% ropivacaine). Postoperative analgesia, recovery duration, and chronic pain were recorded.

Results: Groups R and RD spent less time in the postanaesthesia care unit, had earlier out-of-bed activity, and had shorter postoperative hospital stays compared with group S. The RD group regained consciousness faster and had lower acute pain scores and used less patient-controlled analgesia during the first 72 h after surgery compared with group S. Postthoracotomy pain was decreased in group RD (19.0%) compared with group S (47.6%) 3 months postoperatively, p = 0.050.

Conclusion: Perineural dexamethasone with ropivacaine for TPVB improves postoperative analgesia quality, reduces recovery time, and may decrease the incidence of chronic pain after thoracotomy with an opioid-based anesthetic regimen.

Keywords: chronic pain; dexamethasone; nerve block; thoracotomy.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of the study. Notes: S, saline; R, 0.5% ropivacaine; RD, 5 mg dexamethasone and 0.5% ropivacaine.
Figure 2
Figure 2
Observed mean (SD) heart rate (A) and mean arterial pressure (B) during perioperative period. Notes: S, saline; R, 0.5% ropivacaine; RD, 5 mg dexamethasone and 0.5% ropivacaine; T0, baseline; T1, 5 min after induction; T2, 5 min after paravertebral block; T3, 10 min after skin incision; T4, 10 min after one-lung ventilation; T5, 1 h after one-lung ventilation; T6, 10 min after the end of one-lung ventilation; T7, at the end of surgery; T8, at transfer to the PACU; T9, upon awakening; T10, upon extubation; T11, with transfer from the PACU. Abbreviation: PACU, postanaesthesia care unit.

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