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. 2024 Dec 11:17:99-105.
doi: 10.2147/LRA.S487981. eCollection 2024.

Adding Dexmedetomidine to Methylene Blue in Thoracic Paravertebral Block for Video-Assisted Lobectomy: A Case Series Study

Francesco Coppolino  1 , Simona Brunetti  1 , Leonardo Maria Bottazzo  1 , Gianluigi Cosenza  1 , Pasquale Sansone  1 , Marco Fiore  1 , Maria Beatrice Passavanti  1 , Vincenzo Pota  1 , Maria Caterina Pace  1
Affiliations

Adding Dexmedetomidine to Methylene Blue in Thoracic Paravertebral Block for Video-Assisted Lobectomy: A Case Series Study

Francesco Coppolino et al. Local Reg Anesth. .

Abstract

Purpose: Thoracic surgery often results in severe chronic postoperative pain. Current evidence favors two locoregional techniques. Thoracic Epidural Anesthesia (TEA), the gold standard, and Thoracic Paravertebral Block (TPVB), which is associated with fewer side effects but is limited by short duration of action of local anesthetics (LA) and potential failure due to improper drug distribution. This study investigates the use of dexmedetomidine (DEX) as adjuvant to prolong the effects of LA in TPVB, with methylene blue used for visual confirmation of accurate injectate spread.

Patients and methods: We observed 6 patients undergoing Video-Assisted Thoracoscopy (VATS) lobectomy who received TPVB with ropivacaine, DEX and methylene blue. The primary endpoint was postoperative pain recorded at 1, 12, 24, 48 hours using Numeric Rating Scale (NRS); the secondary endpoints were cumulative opioid consumption in the first 24 hours in Milligram Morphine Equivalents (MME); adverse events: occurrence of bradycardia, hypotension, Postoperative Nausea and Vomiting (PONV); length of hospital stay. All patients completed the study.

Results: Our results showed optimal pain scores, with NRS scores always below 4, decreased need for opioids, and prolonged analgesia. None of the patients had bradycardia nor PONV, but two patients experienced acute and self-limited hypotension following TPVB.

Conclusion: Thoracic Paravertebral Block with Dexmedetomidine and methylene blue was effective and safe in controlling postoperative pain. Methylene blue could help improving knowledge on anesthetics distribution to reduce failure rates.

Keywords: locoregional anesthesia; paravertebral block; post-operative pain; thoracic surgery.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Two cases of methylene blue PVB (A): Methylene blue at T5 during right upper lobectomy. (B): Methylene blue at T4-T5 during left upper lobectomy.
See this image and copyright information in PMC

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