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Levobupivacaine versus Levobupivacaine–Dexmedetomidine in Thoracic Paravertebral Block for Laparoscopic Sympathectomy

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 unilatera...

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Autores principales: Adel Elmaddawy, Alaa Eldin, Diab, Doaa Galal, Farag, Mohammed A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319062/
https://www.ncbi.nlm.nih.gov/pubmed/30662117
http://dx.doi.org/10.4103/aer.AER_126_18
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author Adel Elmaddawy, Alaa Eldin
Diab, Doaa Galal
Farag, Mohammed A.
author_facet Adel Elmaddawy, Alaa Eldin
Diab, Doaa Galal
Farag, Mohammed A.
author_sort Adel Elmaddawy, Alaa Eldin
collection PubMed
description 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.
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spelling pubmed-63190622019-01-18 Levobupivacaine versus Levobupivacaine–Dexmedetomidine in Thoracic Paravertebral Block for Laparoscopic Sympathectomy Adel Elmaddawy, Alaa Eldin Diab, Doaa Galal Farag, Mohammed A. Anesth Essays Res Original Article 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. Medknow Publications & Media Pvt Ltd 2018 /pmc/articles/PMC6319062/ /pubmed/30662117 http://dx.doi.org/10.4103/aer.AER_126_18 Text en Copyright: © 2018 Anesthesia: Essays and Researches http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Adel Elmaddawy, Alaa Eldin
Diab, Doaa Galal
Farag, Mohammed A.
Levobupivacaine versus Levobupivacaine–Dexmedetomidine in Thoracic Paravertebral Block for Laparoscopic Sympathectomy
title Levobupivacaine versus Levobupivacaine–Dexmedetomidine in Thoracic Paravertebral Block for Laparoscopic Sympathectomy
title_full Levobupivacaine versus Levobupivacaine–Dexmedetomidine in Thoracic Paravertebral Block for Laparoscopic Sympathectomy
title_fullStr Levobupivacaine versus Levobupivacaine–Dexmedetomidine in Thoracic Paravertebral Block for Laparoscopic Sympathectomy
title_full_unstemmed Levobupivacaine versus Levobupivacaine–Dexmedetomidine in Thoracic Paravertebral Block for Laparoscopic Sympathectomy
title_short Levobupivacaine versus Levobupivacaine–Dexmedetomidine in Thoracic Paravertebral Block for Laparoscopic Sympathectomy
title_sort levobupivacaine versus levobupivacaine–dexmedetomidine in thoracic paravertebral block for laparoscopic sympathectomy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319062/
https://www.ncbi.nlm.nih.gov/pubmed/30662117
http://dx.doi.org/10.4103/aer.AER_126_18
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