Efficacy of combined thoracic paravertebral block and intravenous dexmedetomidine in medical thoracoscopy

Abstract

Background Medical thoracoscopy has become the gold standard for evaluation of intrapleural space. Thoracic paravertebral block is instillation of local anesthetic drug in the thoracic paravertebral space and can be used in several procedures such as medical thoracoscopy. Dexmedetomidine is a potent α-2 agonist with a higher potency and short duration of action. It has a rapid onset and offset. It produces an ‘interactive’ form of sedation and does not induce respiratory depression. This study was conducted to evaluate the efficacy of paravertebral block with intravenous (i.v.) infusion of dexmedetomidine compared with standardized general anesthesia method in medical thoracoscopy. Patients and methods A randomized controlled trial was conducted in the Department of Chest Diseases at Alexandria Main University Hospital, on patients indicated for medical thoracoscopy. Patients were randomized into two groups (30 patients each). Group A received general anesthesia. Group B received paravertebral block at the level of medical thoracotomy covering three levels: at, above, and below thoracotomy level plus i.v. dexmedetomidine. Demographic data, hemodynamics, patient-rated procedural pain, and operator-rated overall procedure satisfaction scores were recorded. Results A significantly lower means of heart rate and blood pressure were found in group B after thoracotomy and immediately postoperative. Patient-rated procedural pain score in group A ranged from 2 to 5 with a mean of 3.90±0.85, while in group B, it ranged from 0 to 3 with a mean of 1.40±0.68. This difference was statistically significant (P<0.001). A significantly higher operator-rated overall procedure satisfaction score was found in group B (95.77±1.74) compared with group A (90.03±2.33) (P<0.001). Conclusion Use of thoracic paravertebral block plus use of i.v. dexmedetomidine in medical thoracoscopy is comparable to general anesthesia as it is comfortable to the patient and the operator without dealing with airway and its difficulties.