Dexmedetomidine versus dexamethasone as an adjuvant in erector spinae plane block for postoperative pain management in open nephrectomy: A randomized controlled trial

Background: The management of acute postoperative pain is essential for improving patient satisfaction and achieving an improved outcome. The erector spinae plane block (ESPB) can potentially induce sensory blockage on both visceral and somatic levels. The efficacy of nerve block is enhanced, and opioid consumption is reduced by the addition of an adjuvant, such as dexmedetomidine (Dex) or dexamethasone (Dexa). The purpose of this research is to assess the efficacy of Dex and Dexa as adjuvants in ESPB for the management of postoperative pain in patients who underwent open nephrectomy. Methods: A total of 60 patients participated in this randomized, controlled, double-blinded study, 18 to 65 years of age, both sexes and scheduled to undergo an open nephrectomy under general anesthesia. Each patient was assigned to one of three equal categories.: Group Dex: patients received ESPB with the addition of one µg/kg Dex to 29 ml bupivacaine 0.25% as a study group (total volume 30 ml), Group Dexa: patients received ESPB with the addition of 10 mg Dexa to 29 ml bupivacaine 0.25%, Group C: patients not received ESPB as a control group. Results: Heart rate, mean arterial blood pressure and visual analog scale measurements were notably decreased in group Dex when contrasted with group Dexa and group C. The time to first rescue was substantially prolonged in group Dex compared to group Dexa and group C and in group Dexa in comparison to group C. The cumulative morphine consumption in the first 24 hours postoperatively was considerably lower in group Dex than in group Dexa and group C and group Dexa compared to group C. Conclusion: As an adjuvant to bupivacaine in ESPB, Dex is superior to Dexa in hemodynamic stability, pain reduction, delayed time first to rescue, and total opioid consumption.