Evaluation of the effect of dexmedetomidine versus magnesium sulphate as an adjuvant to bupivacaine in ultrasound guided erector spinae block; a prospective randomized trial

Abstract

Background & Objectives: Since the introduction of erector spinae plane block (ESPB) in 2016 it has been used with success in various thoracic, abdominal, and spine surgeries. Spine surgeries result in significant postoperative pain. Postoperative opioids provide adequate pain control in most of the cases, but some patients continue to suffer from uncontrolled pain. Patients receiving multiple doses of opioids suffer from various side effects including postoperative nausea and vomiting, constipation, and delayed ambulation. We aimed to compare effect of dexmedetomidine and magnesium sulfate given as adjuvants with bupivacaine 0.25% for ESPB. Methodology: It was a prospective randomized single-blinded study including 52 patients divided into 2 groups; one receiving ESPB with a combination of bupivacaine 0.25% plus magnesium sulfate and the other receiving the same block with a combination of bupivacaine 0.25% plus dexmedetomidine. Results: The group receiving bupivacaine and dexmedetomidine had a prolonged postoperative analgesia duration as well as a decreased total opioid consumption (P < 0.05) compared to group receiving bupivacaine 0.25% plus magnesium sulfate, but had a significant decrease in intraoperative pulse rate and blood pressure compared to the group receiving bupivacaine 0.25% plus magnesium sulfate (P < 0.05). Conclusion: Although dexmedetomidine results in prolonged postoperative analgesia duration compared to magnesium sulfate when combined with bupivacaine 0.25% in ESPB, its negative effects on hemodynamics should be considered. Trial registration: This trial was registered on clinicaltrials.gov registry (NCT05694897) on 23/1/2023. Abbreviations: ASA: American Society of Anesthesiologist; ESPB: Erector Spinae Block; ERAS: Enhanced recovery After Surgery; SPSS: Statistical Package for Social Sciences; VAS: Visual Analog Score Key words: Erector Spinae Plane Block; Dexmedetomidine; Bupivacaine; Visual Analog Scale Citation: Refaat SA, Abdelmageed WM, Alwedeny HM, Soliman EH, Fouly MA. A randomized comparative trial of ultrasound guided erector spinae block with bupivacaine-magnesium sulphate vs. bupivacaine-dexmedetomidine for lumbar spine surgeries. Anaesth. pain intensive care 2023;27(5):425−430; DOI: 10.35975/apic.v27i5.2292 Received: July 15, 2023; Reviewed: August 16, 2023; Accepted: August 16, 2023