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Pain Management After Thoracotomy With Dexamethasone and Bupivacaine Through a Peripleural Cather: A Randomized Controlled Trial Publisher Pubmed



Talebzadeh H1, 2 ; Eslamian M1, 5 ; Sheikhbahaei E3 ; Esparham A4 ; Zefreh H3 ; Sarblook P1 ; Firouzfar A1
Authors
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Authors Affiliations
  1. 1. Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  2. 2. Anesthesiology and Critical Care Research Center (ACCRC), Isfahan University of Medical Sciences, Isfahan, Iran
  3. 3. Isfahan Minimally Invasive Surgery and Obesity Research Center, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
  4. 4. Student Research Committee, Faculty of Medicine, Mashhad University of Medical since, Mashhad, Iran
  5. 5. Isfahan surgery department, Alzahra University Hospital, Sofe blvd, Isfahan, Iran

Source: BMC Anesthesiology Published:2024


Abstract

Introduction: Thoracotomy procedures can result in significant pain and cause nausea/vomiting. Glucocorticoids have anti-emetic and analgesic effects due to their anti-inflammatory and nerve-blocking properties. This study investigates the additive effect of local dexamethasone with bupivacaine as sole analgesic medication through a peripleural catheter after thoracotomy. Method: The study was conducted as a randomized control trial on 82 patients. Participants were allocated to receive either 2.5 mg/kg of bupivacaine plus 0.2 mg/kg of dexamethasone or 2.5 mg/kg of bupivacaine plus the same amount of normal saline as placebo through a 6 French peripleural catheter implemented above the parietal pleura and beneath the musculoskeletal structure of the chest wall. The primary outcome was the severity of pain 24 h after the operation in the visual analogue scale (VAS) score. Secondary outcomes were the incidence of nausea/vomiting, opioid consumption for pain control, and incidence of any adverse effects. Results: : A total of 50 participants were randomized to each group, and the baseline characteristics were similar between the groups. Median of VAS score (6 (3-8) vs. 8 (6-9), p < 0.001), postoperative opioid consumption (9 (36%) vs. 17 (68%) patients, p=0.024), and median length of hospital stay (4 (3-8) vs. 6 (3-12) days, p < 0.001) were significantly lower in the dexamethasone group. However, postoperative nausea/vomiting (p=0.26 for nausea and p=0.71 for vomiting) and surgical site infection (p = 0.55) were similar between the two groups. Conclusion: In thoracotomy patients, administering local dexamethasone + bupivacaine through a peripleural catheter can reduce postoperative pain, analgesic consumption, and length of hospital stay. Trial Registration: Iranian Registry of Clinical Trials (IRCT20220309054226N1, registration date: 3/21/2022. © The Author(s) 2024.
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