Background: Postoperative pain is a major problem associated with any surgery. Thoracic surgeries result in excessive breakthrough pain which should be countered appropriately to decrease postoperative poor ventilation. Extrapleural paravertebral catheter is one such modality effective for postoperative pain caused by thoracic surgeries, comparable to thoracic epidural. Adjuvants like fentanyl or dexmedetomidine not only reduce the total local anesthetic dose but also provide superior and profound analgesia.
Aims and Objectives: To compare the effect of bupivacaine with fentanyl or with dexmedetomidine via extrapleural paravertebral catheter for continuous postoperative analgesia.
Materials and Methods: Our study was a prospective, randomized, and comparative study conducted in the Department of Anesthesiology, M.Y. Hospital and M.G.M. Medical College, Indore. A total of 40 patients (taking the COVID era into consideration) aged between 18 to 65 years with ASA Grade I, II \& III undergoing thoracic surgeries were included. Patients were divided into two groups of 20 each: Group (B+F) who received 0.125\& Bupivacaine along with Fentanyl 2 mcg/ml @ 0.15ml/kg/hr and Group (B+D) who received 0.125\& Bupivacaine with Dexmedetomidine 0.2 mcg/kg/hr @ 0.1ml/kg/hr via extrapleural paravertebral catheter.
Results: The mean PEFR was comparable between the two groups at 12 hours (P=0.198), 24 hours (P=0.058), 48 hours (P=0.15), and 72 hours (P=0.10). Improvement in PEFR was observed in both groups from 12 hours to 72 hours, with group 1 (B+F) showing 348.00 \(\pm\) 18.317 L/min at 12 hours and 521.50 \(\pm\) 24.468 L/min at 72 hours, while group 2 (B+D) showed 355.50 \(\pm\) 15.39 L/min at 12 hours and 535.00 \(\pm\) 28.562 L/min at 72 hours, indicating improvement in lung function. The mean time taken for the request to first analgesia in Group 1 (B+F) was 259.15 \(\pm\) 11.536 minutes and in Group 2 (B+D) was 360.2 $\pm$ 13.671 minutes, and this mean time was found to be statistically significant between the two groups (P=0.000*).
Conclusion: The mean VAS score (visual analog scale) noted at 72 hours with coughing was better with dexmedetomidine than with fentanyl. The mean time taken for the request to first rescue analgesia in group B+F was 259.15 \(\pm\) 11.536 minutes, and in group B+D, it was 360.20 $\pm$ 13.671 minutes, which was significantly higher in the dexmedetomidine-containing group. A more stable hemodynamic profile was observed in the B+D group.
