Abstract

Thoracotomy surgeries are usually painful where improper pain management can lead to complications including respiratory failure, atelectasis, and pneumonia. Also, the chronic post-thoracotomy pain (CPTP), seen in 30-50% of subjects following thoracotomy can persist for months which can lower their quality of life to a wide extent. As limited duration analgesia is provided by a single dose of local anaesthetics, adjuvants are usually used to achieve long-duration analgesia in peripheral nerve blocks. Aim: The present study was conducted to assess the efficacy of dexamethasone alone to perineural dexamethasone with ropivacaine in providing postoperative analgesia in TPVB (Thoracic paravertebral block) during elective thoracotomy. Materials and Methods: In 105 subjects undergoing thoracotomy were randomly assigned into three groups having 35 subjects each were Group I was treated with saline, Group II with ropivacaine 0.5%, and Group III combination of 5mg dexamethasone and 0.5 percent ropivacaine). The parameters assessed in the three Groups were chronic discomfort, recuperation time, and postoperative analgesia. Results: duration for PACU stay was 126.68±74.94, 86.56±30.32, and 82.41±30.05 mins for Group I, II, and III respectively which was statistically significant for Group I and II, and Group II and III with respective p-values of 0.006 and 0.005, whereas, it was non-significant between Group I and III (0.783). The awakening time for the I, II, and III group was 68.50±71.33, 45.40±28.78, and 35.22±19.28 mins respectively where it was statistically significant between Group II and III with p=0.02, and non-significant between Group I and II and I and III with p-values of 0.093 and 0.465. Mean postoperative hospital stay in Group I, II, and III subjects was 16.63±12.44, 10.86±3.17, and 11.64±3.42 respectively which was statistically non-significant with p1, p2, and p3 values of 0.746. VAS was statistically non-significant at 12, 48, and 72 hours with p-values of 0.912, 0.683, and 0.533 respectively, whereas, VAS was statistically significant on the intergroup comparison at day 24 was <0.0001 Conclusion: The present study concludes that using opioid-based anesthetic protocol using perineural dexamethasone with ropivacaine in Thoracic paravertebral block has added advantages of decreased incidence of chronic pain, less recovery time, and better analgesia quality after thoracotomy.

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