Background: Erector Spinae Plane Block (ESPB) is a simple and safe analgesic technique to relieve thoracotomy pain, but we need to increase the duration of analgesia with a single shot. so, we compared the analgesic efficacy of Dexmedetomidine (DEX) versus ketamine as an adjuvant to bupivacaine ESPB in children scheduled for thoracotomy cardiothoracic surgeries.
Methods: 90 children aged 3 to 36 months, scheduled for thoracotomy cardiothoracic surgeries, were divided into group Bupivacaine (B) (n=30) and received ESPB using 0.5 ml/kg bupivacaine 0.25% in 15 ml saline. Group Bupivacaine-ketamine (BK) (n=30) received the same as group B plus ketamine 2 mg/kg. Group Bupivacaine-Dexamedetomedine (BD) received the same as group B plus dex 1 μg/kg. The time to first rescue analgesia, perioperative hemodynamics, postoperative pain intensity, total consumption of opioids, and frequency of complications were measured.
Results: The addition of dexmedetomidine and ketamine to bupivacaine resulted in a significant prolongation of postoperative analgesia duration (16.4 ± 3.79 hr,95%CI: 14.951:17.783, P<0.001) and(10.1 ± 2.36 hr,95%CI: 9.184:10.949, P<0.001), respectively compared with 0.5% bupivacaine alone (5.2 ± 1.26 hr. 95%CI: 4.714:5.625). postoperative analgesia duration was more prolonged in the BD group than in the Bk group( P<0.001). with lower perioperative opioid consumption, better hemodynamic profile, and better predictive indexes (extubation time and hospital stay) in the BD and BK groups than in the B group.
Conclusion: Dexmedetomidine as an adjuvant to bupivacaine provides a longer duration of analgesia as compared to ketamine without any significant side effects.