Comparative Study of Patients Outcomes by Using Dexmedetomidine with Bupivacaine Versus Bupivacaine Alone in Ultrasound-Guided Thoracolumbar Interfacial Plane Block for Spine Surgeries

Background: Thoracolumbar interfacial plane block (TLIP) is effective and safe method used with general anesthesia to achieve the optimum analgesia. This study evaluates theanalgesic effect, hemodynamic changes, consumption of inhalational anesthesia and stress response by measuring cortisol level when adding dexmedetomidine to bupivacaine in the ultrasound-guided thoracolumbar interfacial plane block in spine surgeries (lumber and lower thoracic T11-T12).

Patients and Methods: sixty adult patients of both sexes aged (21-60) years with ASA physical status I/II scheduled for elective spine surgeries (laminectomy and spinal fixation) at the level of lower thoracic (T11-T12) and lumber vertebra. Patients divided into two groups, group A of thirty patients were given 20 ml of 0.25% bupivacaine with 1ml normal saline, at each side injected between multifidus muscle and longissimus muscle and group B of thirty patients were given 20ml of 0.25% bupivacaine with dexmedetomidine 1 mic/kg in a volume of 1 ml, at each side between multifidus muscle and longissimus muscle.

Results: There was significantly decrease in NRS as a primary outcome in group B compared to group A, and according to the secondary outcomes there were significantly decrease in serum cortisol level, consumption of isoflurane, MAP, heart rate, number of total doses of rescue analgesia and number of patients received an algesia and delay in 1st dose of rescue analgesia in groupB compared to group A and there was insignificant difference in time of extubating between both groups.

Conclusion: We concluded that adding dexmedetomidine in a total dose 2 mic/kg as we added 1 mic/kg in a volume of 1 ml to 20ml of 0.25% bupivacaine for each side in TLIP block decreases stress response to surgery, total consumption of inhalational anesthesia (isoflurane), number of patients need rescue analgesia and total doses of rescue analgesia, and delayed 1st dose of rescue analgesia.