Levobupivacaine versus levobupivacaine – dexmedetomidine for ultrasound guided bilateral superficial cervical plexus block for upper tracheal resection and reconstruction surgery under general anesthesia

Abstract

Background Anesthesia for repair of tracheal stenosis considered as a challenging that needs to optimize the immediate postoperative period and preventing unwise use of postoperative opioid. This study was designed to evaluate the analgesic efficacy of adding dexmedetomidine to levobupivacaine for blocking the superficial cervical plexus for tracheal reconstruction. Methods Eighty patients, underwent elective surgical repair of upper tracheal stenosis and reconstruction. Patients were randomly allocated into two groups and received ultrasound guided bilateral superficial cervical plexus block. Group L received 10 ml of 0.5% Levobupivacaine. Group D received 10 ml of 0.5% Levobupivacaine and 0.5 µg⁄kg dexmedetomidine in each side. The total postoperative analgesic consumption, postoperative pain severity and the time to the first analgesic requirement were evaluated in all patients. Results Total postoperative fentanyl consumption decreased in group D (76.75 ± 9.57 µg) versus (176.75 ± 22.66 µg) in group L with p value ≤ 0.001 and time to first analgesic requirement was longer in group D (20.70 ± 5.42 hours) versus (8.35 ± 2.55 hours) in group L. Moreover, increased plasma cortisol level during surgery and after recovery in group L compared with group D with p value ≤ 0.001. Conclusion : Addition of dexmedetomidine to levobupivacaine for bilateral superficial cervical plexus block considered as an effective and safe block that significantly reduced total postoperative opioid consumption and prolonged time to first postoperative analgesic request with achievement of good quality of analgesia.

Keywords

• dexmedetomidine
• superficial cervical plexus block
• tracheal resection