Dexamethasone as an adjuvant to continuous erector spinae plane block for postoperative analgesia after video-assisted thoracoscopic surgery for pulmonary nodule surgery: a randomized controlled trial.
Liang Fang, Haolin Zhang, Jia Nie et al.
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In 30 seconds
This randomized controlled trial studied 85 patients undergoing video-assisted thoracoscopic surgery for pulmonary nodule surgery with continuous erector spinae plane block (ESPB). Patients received ropivacaine infusion with or without 10 mg dexamethasone. Adding dexamethasone improved pain control, with lower resting pain at 12 hours (2.56 [1.03] vs 3.24 [1.21]) and analgesic benefit sustained through 72 hours. It was also associated with lower tramadol use and shorter hospital stay. The intervention did not reduce chronic postsurgical pain at 3 months (31% vs 34%, p = 0.756).
Key findings
- At 12 hours, resting pain was lower with dexamethasone: 2.56 (1.03) vs 3.24 (1.21), mean difference -0.680, p = 0.006.
- Total tramadol consumption over 72 hours was 0 (0,100) vs 100 (75,100), z = -3.807, p < 0.001, with dexamethasone versus control.
- Hospital stay was 6.09 (1.34) d vs 6.93 (1.55) d, p < 0.001, with dexamethasone versus control.
- Chronic postsurgical pain at 3 months was not reduced: 31% vs 34%, p = 0.756.
Why it matters
Continuous ESPB is used to manage postoperative pain after thoracoscopic surgery. In this trial, adding dexamethasone improved early analgesia and recovery measures and reduced tramadol consumption, while not changing chronic pain incidence. These findings distinguish short-term benefits from longer-term pain outcomes and may inform evaluation of adjuvants in continuous regional analgesia.
What to keep in mind
The trial included 85 patients, and the reported chronic pain outcome was assessed at 3 months; longer-term effects are not established by the abstract.