Efficacy of Dexmedetomidine as an Adjuvant to Ropivacaine for Intercostal Nerve Block in Elderly Patients Undergoing Video-Assisted Thoracoscopic Esophagectomy: A randomized Double-Blinded Trial.

Abstract

Background: Esophagectomy is associated with significant postoperative pain and a pronounced perioperative stress response. Dexmedetomidine (DEX) has been widely recognized as an effective adjuvant to regional anesthesia across various surgical procedures. However, its efficacy and safety as an adjuvant to ropivacaine in elderly patients undergoing thoracoscopic esophagectomy remain unclear. This study aimed to evaluate the effectiveness and safety of DEX.

Methods: A total of 89 patients with the American Society of Anesthesiologists (ASA) physical status I-III were randomly assigned to two groups. The DR group received an intercostal nerve block with a mixture of 20 mL of 0.25% ropivacaine and 2 μg/kg of DEX, while the RP group received 20 mL of 0.25% ropivacaine alone. Plasma levels of epinephrine (E), norepinephrine (NE), and cortisol (COR) were measured perioperatively. Postoperative analgesia was assessed using the Visual Analog Scale (VAS), the cumulative dose of rescue analgesics, and the pump pressure required for rescue analgesia. Additionally, adverse events and satisfaction scores from both patients and thoracic surgeons were recorded. The Shapiro-Wilk test was applied for uniformly distributed. The values for baseline information were presented as the mean ±standard (SD), and compared using one-way ANOVA. Enumeration data were expressed as percentages or frequencies and compared using the Chi-square test.

Results: Postoperatively, plasma levels of E, NE, and COR decreased significantly in the DR group compared to the RP group. The duration of analgesia was longer in the DR group, with fewer requirements for rescue analgesia and a significantly extended time to the first analgesic request. VAS scores were significantly lower in the DR group. No significant adverse events were observed, and patient satisfaction with analgesia was significantly higher in the DR group.

Conclusion: DEX, when used as an adjuvant to intercostal nerve block, prolongs analgesic duration, improves pain control, and attenuates the perioperative stress response in elderly patients undergoing thoracoscopic esophagectomy.