Alansary Amin M, Ali Mohamed Mourad, Elshafie Minatallah Ali, Elbeialy Marwa A K
Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo.
Department of Anesthesia, National Liver Institute, Menoufia University, Shebeen Elkom City, Egypt.
Clin J Pain. 2025 Aug 1;41(8):e1299. doi: 10.1097/AJP.0000000000001299.
There is a scarcity of research regarding the effects of local anesthetic adjuvant drugs in erector spinae plane block (ESPB), especially in scoliosis surgery. This study aimed to compare dexmedetomidine (DEX) or magnesium sulfate (MgSO 4 ) as adjuvants for bupivacaine in bilateral bi-level ultrasound-guided ESPB (USG-ESPB) in patients undergoing corrective scoliosis surgery.
In this prospective, randomized study, 60 patients aged 14 to 25 years were randomly assigned to 1 of 3 groups (in a 1:1:1 ratio) after induction of general anesthesia. The DEX group [n=20] received USG-ESPB with 20 mL of bupivacaine 0.125% plus 0.25 µg/kg of DEX for each injection, whereas the MgSO 4 group [n=20] received USG-ESPB with 20 mL of bupivacaine 0.125% plus 2 mg/kg MgSO 4 for each injection. The control group [n=20] received conventional perioperative analgesia. The primary outcome was time for the first rescue analgesia. Secondary outcomes included total morphine consumption and pain scores in the first 48 postoperative hours. Hemodynamic parameters were assessed.
The mean time to the first analgesic request was the longest among patients in the DEX group ( P <0.001). In addition, the total morphine consumption and the 48-hour time-weighted average pain score during rest and movement were significantly lower among the patients in the DEX group ( P <0.001). However, DEX was associated with a significant decrease in hemodynamic parameters ( P <0.001).
Both DEX and MgSO 4 provided a satisfactory pain relief profile. However, DEX with bupivacaine provided a longer period of analgesia.
关于局部麻醉辅助药物在竖脊肌平面阻滞（ESPB）中的作用，尤其是在脊柱侧弯手术中的研究较少。本研究旨在比较右美托咪定（DEX）或硫酸镁（MgSO₄）作为布比卡因辅助药物在双侧双平面超声引导下ESPB（USG - ESPB）用于脊柱侧弯矫正手术患者的效果。
在这项前瞻性随机研究中，60例年龄在14至25岁的患者在全身麻醉诱导后被随机分为3组（比例为1:1:1）。DEX组[n = 20]每次注射接受含20 mL 0.125%布比卡因加0.25 μg/kg DEX的USG - ESPB，而MgSO₄组[n = 20]每次注射接受含20 mL 0.125%布比卡因加2 mg/kg MgSO₄的USG - ESPB。对照组[n = 20]接受常规围手术期镇痛。主要结局是首次补救镇痛的时间。次要结局包括术后48小时内的吗啡总消耗量和疼痛评分。评估血流动力学参数。
DEX组患者首次镇痛需求的平均时间最长（P < 0.001）。此外，DEX组患者的吗啡总消耗量以及休息和活动时48小时时间加权平均疼痛评分显著更低（P < 0.001）。然而，DEX与血流动力学参数的显著降低相关（P < 0.001）。
DEX和MgSO₄均提供了令人满意的疼痛缓解情况。然而，DEX与布比卡因联合使用提供了更长时间的镇痛效果。
