Ultrasound guided bilateral superficial cervical plexus block versus intravenous ketamine and dexmedetomidine infusion as opioid sparing analgesia for upper tracheal resection and reconstruction surgeries: a randomized comparative study

INTRODUCTION: A common indication for tracheal resection and reconstruction (TRR) is tracheal stenosis secondary to prolonged intubation. The objective of this trial is to evaluate the efficacy of bilateral superficial cervical plexus block (BSCPB) compared with IV infusion of ketamine and dexmedetomidine as opioid-sparing analgesic approaches for TRR. MATERIALS AND METHODS: 66 patients scheduled for TRR were randomized to receive either BSCPB (BSCP group) or an IV infusion of ketamine and dexmedetomidine (KD group). The primary outcome was the duration of analgesia. Secondary outcomes were 24-hour postoperative fentanyl consumption, VAS scores at 2, 4, 6, 12, and 24 hours postoperatively, postoperative agitation score, and complications. RESULTS: The BSCP group had a mean analgesic duration of 10.39 ± 2.50 hours, whereas the KD group had a mean of 6.02 ± 1.89 hours. The VAS score was significantly lower in the BSCP group than in the KD group at 4, 6, 8, and 12 hours post-operatively. The KD group received a larger Fentanyl dose than the BSCP group. CONCLUSION: Ultrasound-guided BSCPB demonstrated a superior analgesic profile with less opioid consumption, with no differences in reported complications. CLINICAL TRIAL REGISTRATION: The pactr.samrc.ac.za identifier is PACTR202408626945341.