Opioid-sparing effect of erector spinae plane block and intravenous dexmedetomidine for obese patients with obstructive sleep apnea: A randomized controlled trial

Mona Raafat Elghamry; Atteia Gad Anwar; Shaimaa Waheed Zahra

doi:10.5055/jom.0873

Authors

Mona Raafat Elghamry, MD https://orcid.org/0000-0002-7087-864X
Atteia Gad Anwar, MD https://orcid.org/0000-0002-2866-1295
Shaimaa Waheed Zahra, MD https://orcid.org/0000-0002-7835-3653

DOI:

https://doi.org/10.5055/jom.0873

Keywords:

analgesia, bariatric surgery, dexmedetomidine, erector spinae plane block, fentanyl, obstructive sleep apnea

Abstract

Objective: This study assessed the impact of erector spinae plane block (ESPB) and intravenous (IV) dexmedetomidine in reduction of perioperative opioid consumption following bariatric surgery and their impact on post-operative recovery, analgesia, and pulmonary functions.

Design: A randomized controlled trial.

Setting: Tanta University Hospitals, Tanta, Gharboa, Egypt.

Patients: Forty obese patients with obstructive sleep apnea syndrome (OSAS), aged 20-55 years, and eligible for bariatric surgery were included.

Interventions: Patients randomized into group I (received general anesthesia [GA] with opioid, sham ESPB, and IV normal saline) or group II (received GA [without opioid], ESPB [at T7 level] using 20 mL bupivacaine 0.25 percent and bolus IV dexmedetomidine 1 μg/kg and then 0.25 μg/kg/h).

Main outcome measures: Fentanyl consumption (primary outcome), sevoflurane consumption, recovery time, Visual Analog Scale (VAS), and pulmonary functions (secondary outcomes) were recorded.

Results: Perioperative fentanyl (intraoperative, post-operative, and total) consumption and sevoflurane consumption were substantially lower in group II compared to group I (p = 0.010, <0.001, <0.001, and <0.001, respectively). Moreover, recovery time was shorter in group II (p < 0.001). At 2, 4, 8, and 24 hours after surgery, group I patients had VAS values considerably higher. Relative to preoperative values, pulmonary function did not significantly alter after surgery. Oxygen desaturation was significantly lower in group II (p = 0.001).

Conclusions: The ESPB with IV dexmedetomidine is advantageous for OSAS patients having bariatric surgery as it provides anesthesia and opioid-sparing effect with short recovery, adequate analgesia, and nonsignificant complications. Yet, it had no effect on post-operative pulmonary function.

Author Biographies

Mona Raafat Elghamry, MD

Assistant Professor of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt

Atteia Gad Anwar, MD

Assistant Professor of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt

Shaimaa Waheed Zahra, MD

Lecturer of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt

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