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Improvement in postoperative pain control by combined use of intravenous dexamethasone with dexmedetomidine after erector spinae plane block and serratus anterior plane block for thoracoscopic surgery: a randomized controlled trial

BMC Anesthesiology volume 25, Article number: 171 (2025) Cite this article

Abstract

Background

Acute pain after thoracoscopic surgery is very noticeable and often requires additional techniques or adjunctive medications to reduce it. We investigated whether intravenous dexamethasone with dexmedetomidine after erector spinae plane block and serratus anterior plane block could further decrease the incidence of moderate-to-severe pain.

Methods

A total of 81 patients were randomly assigned to group C (20 mL normal saline), group S (10 mg dexamethasone + normal saline to 20 mL), or group SM (10 mg dexamethasone + 1 µg/kg dexmedetomidine + normal saline to 20 mL). All patients underwent erector spinae plane block and serratus anterior plane block 30 min before anesthesia induction and all drugs were infused intravenously 30 min after general anesthesia induction. The primary outcome was incidence of moderate-to-severe pain at 24 h on movement postoperatively. Secondary outcomes included incidence of moderate-to-severe pain on movement and at rest throughout the first two postoperative days, pain score, opioid consumption, quality of recovery and adverse effects.

Results

Group SM lowered the incidence of moderate-to-severe pain on movement at 24 h postoperatively than group C (11.1% vs. 48.0%; RR 0.231; 95% CI, 0.074 to 0.725) and group S (11.1% vs. 38.5%; RR 0.289; 95% CI, 0.089 to 0.933). Group SM reduced NRS score on movement (3.0 [3.0] vs. 3.0 [2.0] vs. 3.0[1.0]; P < 0.001) and total opioid consumption (26.0 [6.0] vs. 32.0 [9.0] vs. 28.0 [2.5]; P = 0.004) within 24 h after surgery, fewer patients required rescue analgesia (11.1% vs. 48.0% vs. 38.5%; P = 0.009). Group SM also lowered incidence of nausea and vomiting (7.4% vs. 32.0% vs. 30.8%; P = 0.047) and had a higher QoR-15 score at postoperative 24 h (132.0 [10.0] vs. 123.0 [8.0] vs. 127.5 [10.8]; P < 0.001).

Conclusions

Intravenous administration of dexamethasone with dexmedetomidine after erector spinae plane block and serratus anterior plane block further decreased the incidence of moderate-to-severe pain. It also reduced NRS scores and opioid consumption, making the postoperative pain control better for thoracoscopic surgery.

Trial registration

The study was registered at Chictr.org.cn with the number ChiCTR2400084435 on 05/16/2024.

Peer Review reports

Background

Thoracoscopic surgery is minimally invasive, but postoperative pain is still significant [1]. Insufficient analgesia would affect the patient’s cough and sputum, increase postoperative pulmonary complications, and delay rapid recovery [2–3]. PROSPECT guidelines for thoracoscopic surgery: a systematic review and recommendations for postoperative pain management: some additional techniques or adjunctive medications are recommended to relieve acute postoperative pain [4].

Fascial plane blocks, whether erector spinae plane block or serratus anterior plane block, are far away from the spinal cord, blood vessels and pleura, effectively reducing damage and making it safer [5–6]. The combination of the two, which Mario et al. [7] believed may reduce the risk of systemic toxicity of local anesthetics, and Mo X et al. [8], which suggested can complement each other and produce a broader analgesic effect. However, due to the duration of the local anesthetic, the analgesic time of the nerve block cannot be extended to 24 h or even 48 h postoperatively, which is the most painful phase postoperatively [9].

Therefore, some adjunctive drugs are still needed, and dexamethasone and dexmedetomidine are the two most commonly used [10]. Umari M et al. [2] said that compared with other adjuvant drugs, dexamethasone and dexmedetomidine prolonged the analgesia time after peripheral nerve block more significantly, with an average of six hours for dexamethasone and four hours for dexmedetomidine. Kang RA et al. [11] added that the mechanisms of the two drugs are different, and that the combination is expected to further prolong the duration of analgesia, and the underlying mechanism may be explained by the additive model of effects, that is, the analgesic dose of the second drug significantly increases the analgesic effect produced by a single dose of a given drug.

However, the effectiveness and safety of such a multimodal analgesic protocol, emphasizing a combination of different analgesic mechanisms to optimize postoperative pain control, are unclear. As a result, we designed a randomized controlled trial to evaluate whether intravenous administration of dexamethasone with dexmedetomidine after erector spinae plane block and serratus anterior plane block could further improve analgesia control after thoracoscopic surgery. We hypothesized that this combination regimen would significantly reduce the incidence of moderate-to-severe postoperative pain and hopefully be safer and more effective.

Methods

Study design

This is a double-blind, prospective randomized controlled trial conducted from May 16, 2024 to July 31, 2024 at the Affiliated Hospital of Xuzhou Medical University. The study was approved by the Ethics Committee of The Affiliated Hospital of Xuzhou Medical University (XYFY2024-KL193-01) and was registered at the Chinese Clinical Trial Registry (ChiCTR2400084435; registration date: May 16, 2024). All subjects were provided with written informed consent to participate in this study and all experiments were performed in accordance with relevant guidelines and regulations.

Participants

A total of 81 patients aged 18–65 years who underwent elective thoracoscopic surgery at ASA I-III were included. Exclusion criteria included: contraindications to regional nerve blocks, including skin infections or bleeding disorders at the block site; allergies and contraindications to any of the drugs used in this trial; severe cardiovascular and cerebrovascular, respiratory diseases, diabetes mellitus, and abnormal liver and kidney function were present before surgery; history of chronic pain, long-term use of opioids, hormones, or non-steroidal drugs; inability to communicate normally: hearing impairment, language comprehension impairment, mental illness, etc.; bradycardia (< 50 beats/minute); BMI ≥ 30 kg/m2; having participated in other studies.

Randomization and blinding

One day before surgery, one researcher (YX-M) blinded to group assignment collected data and obtained written informed consent in wards. After enrollment, one researcher (ZJ-L) randomly assigned participants to the following groups: group C (20 mL normal saline), group S (10 mg dexamethasone + normal saline to 20 mL), or group SM (10 mg dexamethasone + 1 µg/kg dexmedetomidine + normal saline to 20 mL) according to a computer-generated allocation list (simple randomization) with a 1:1:1 ratio in SPSS™ 22.0 (IBM, Chicago, IL, USA). Assignment concealment was achieved by using an opaque sealed envelope.

Before the surgery, an anesthesia nurse who was also not aware of the group assignment opened the envelope and prepared all the medications needed. Then, an experienced anesthesiologist (ZW-L) performed nerve blocks and anesthesia induction. Because of the hemodynamic properties of the drugs, it was difficult for the anesthesiologist to be completely blinded, but she was not involved in postoperative recovery and evaluation. After the surgery, a researcher (SM-Y) blinded to group assignment followed up and collected data.

Surgical procedure

All patients were operated by a fixed surgeon on a standardized procedure. Participants were placed in the lateral position, with a 5 cm cotton chest pad below the shoulder to help maximize the intercostal space at the surgical incision. A 5 cm incision was made in the 4th or 5th intercostal space at the anterior to mid-axillary line according to the widest intercostal space palpated after positioning. The tissue was separated layer by layer, gradually entered the thoracic cavity, and standardized treatment was carried out according to the surgical plan discussed before surgery. Whenever possible, the surgeon avoided cutting or persistently compressing the intercostal nerves or stretching the intercostal space. Finally, a 24 F chest tube was placed at the incision site to a depth of approximately 5 cm, which was confirmed by thoracoscopic evidence that the pleura was not compressed. At the end of the procedure, both lungs were reinflated and the incisions were closed. The chest tube was attached to a water-sealed bottle.

Anesthesia procedure

After the patient was admitted to the operatory room, ECG, IBP, SpO2 were routinely monitored, peripheral venous access was opened, and intravenous bolus midazolam 0.02 mg/kg and sufentanil 0.08 µg/kg were injected.

Thirty minutes before surgery, the lateral erector spinae plane block and serratus anterior plane block were performed under ultrasound guidance. Three groups of patients were placed in the healthy lateral decubitus position, disinfected and spread towels, and used in-plane technology to insert needles in 2–3 cm next to the spinous processes of T4 and T5, and passed through the trapezius muscle, rhomboid muscle, and erector spinae muscle from shallow to deep, and injected 20 ml of 0.375% ropivacaine into the deep surface of the erector spinae muscle when the needle tip touched the top of the T5 transverse process [12]. The needle was inserted using an in-plane technique along the level of the midline of the 5th rib axillary to clearly visualize the superficial latissimus dorsi and the deep serratus anterior muscle, and 20 ml of 0.375% ropivacaine was injected when the needle tip reached the serratus anterior surface [13]. Assist the patient to take a supine position, and after 15 min, the sensory block plane is measured by skin cold perception test, and the combined block is considered successful if the sensory hypoesthesia or sensory loss is measured in both the anterior and posterior midlines.

After the onset of the block, anesthesia induction was started in the three groups, and etomidate 0.3 mg/kg, midazolam 0.05 mg/kg, sufentanil 0.5 µg/kg, and rocuronium bromide 0.9 mg/kg were given. Mechanical ventilation was followed by fiberoptic bronchoscope-guided tracheal intubation. Among 30 min after induction, intravenous infusion of the control group: 20 ml of normal saline; dexamethasone group: 10 mg dexamethasone + normal saline to 20 ml; dexamethasone with dexmedetomidine group: 10 mg dexamethasone + 1 µg/kg dexmedetomidine + normal saline to 20 ml. Intravenous compound inhalation anesthesia was used for maintenance: intraoperative sevoflurane inhalation 1–2%, continuous intravenous pumping of propofol 2–6 mg/kg/h, remifentanil 0.1–0.3 µg/kg/min. During the operation, the anesthesiologist adjusted the infusion rate of the drug to maintain the BIS value of 40–60 at the depth of anesthesia and kept the blood pressure and heart rate within ± 20% range compared to baseline values.

Inhalation anesthetic was stopped 30 min before the end of the operation, and then flurbiprofen cilofen 50 mg was administrated. Patient was transferred to the PACU, the double-lumen bronchial tube was removed after the extubation criteria were met, and the patient was returned to the ward when the Aldrete score ≥ 9.

The postoperative PCIA pump contained sufentanil 2 µg/kg + tropisetron 6 mg, and normal saline diluted to 100 ml. There was no background infusion volume, PCIA dose was 2 ml/time, and the locking time was 15 min. When patients felt pain, they could press the PCIA button repeatedly until feeling relief. If the postoperative NRS score ≥ 4, bucinazine hydrochloride 100 mg intramuscularly was given for relief analgesia. If the postoperative NRS score ≥ 7, tramadol hydrochloride 100 mg intramuscularly was given.

Outcome measurements

The primary outcome was incidence of moderate-to-severe pain at postoperative 24 h on movement. Movement was defined as three times of deep breath and cough once. Using NRS to evaluate the pain level, 0–10 point overall, 0 is no pain, 1–3 is mild pain, 4–6 is moderate pain, and 7–10 is severe pain [14]. We defined NRS ≥ 4 as moderate-to-severe pain.

Secondary outcomes included: (1) incidence of moderate-to-severe pain on movement and at rest at 6 h, 12 h, 24 h, 36 h and 48 h; (2) total opioid consumption (converted to morphine equivalent) within 24 h and 48 h; (3) number of patients required rescue analgesia within 24 h and 48 h; (4) time to first eating, first ambulation, and remove chest drain, length of stay; (5) QoR-15 score (0-150 point overall, the higher the score, the better the quality of recovery [15]) at 24 h; (6) possible adverse effects: nausea and vomiting, bradycardia (heart rate < 20% of baseline), hypotension (MAP < 20% of baseline), hypoxemia (SpO2 < 90%), drowsiness, dizzy, pruritus, local/systemic infection, neurological symptoms (persistent numbness or paresthesias, weakness or non-surgical pain), etc.

Sample size calculation

The incidence of moderate-to-severe pain after thoracoscopic surgery is 55%, and previous studies have shown that nerve block can reduce it by about 25%. This study hypothesized that dexamethasone with dexmedetomidine would make sense to reduce moderate-to-severe pain by an additional 20% after thoracoscopic surgery. Using PASS15.0 calculation, the test power was defined as 90%, the test level was 0.05, the sample size was 63, and the dropout rate of 20% was considered, 27 cases were included in each group, and 81 cases were planned to be included in this study.

Statistical analysis

SPSS 26.0 software was used for statistical analysis. For quantitative data, Shapiro-Wilk’s test to determine its normality; The normally distributed continuous data were expressed as mean ± SD. One-way ANOVA was used for comparison at the same time point between the three groups, and repeated measures ANOVA was used for comparison at different time points within the group. The non-normally distributed continuous data were expressed as median (interquartile range), and the Kruskal-Wallis H test was used for comparison between the three groups at the same time point. The Friedman test was used for comparison at different time points within the group. The count data were expressed as rates, and the chi-square test or Fisher’s exact probability method was used for comparison. The Kruskal-Wallis H test was used for the comparison of grade data. Survival data were analyzed by Kaplan-Meier curve, and the differences between groups were compared by log-rank test. In the case of statistically significant differences between multiple groups, post-hoc analysis was performed using Bonferroni correction, and the significance criterion for each pairwise comparison was P < 0.0167 after correction; Otherwise, P < 0.05 indicated that the difference was statistically significant.

Results

A total of 81 patients were included and randomized. During the study period, 3 patients were transferred to thoracotomy due to difficult surgery or excessive bleeding, and finally 78 patients were included in the intention-to-treat analysis (Fig. 1).

Fig. 1
figure 1

Consort flowchart of the study

Full size image

The baseline characteristics and intraoperative data of the three groups were well balanced, but the intraoperative dose of remifentanil was significantly lower in group S and group SM compared with group C (P < 0.05; Table 1). In terms of vital signs, compared with group C, group SM and group S both seemed to be smoother (Fig. 2).

Table 1 Patient demographic and surgical data
Full size table
Fig. 2
figure 2

MAP and heart rate in different times. Data are expressed as mean ± SD. By Bonferroni adjustment, *: Group SM vs. group C, P < 0.05; #: Group S vs. group C, P < 0.05

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Group SM significantly lowered the incidence of moderate-to-severe pain on movement at 24 h postoperatively than group C (11.1% vs. 48.0%; RR 0.231; 95% CI, 0.074 to 0.725) and group S (11.1% vs. 38.5%; RR 0.289; 95% CI, 0.089 to 0.933). At rest at 24 h after surgery, the result was consistent with which on movement (7.4% vs. 32.0% vs. 30.8%; P = 0.047). There was no significant difference between the three groups in the incidence of moderate-to-severe pain at other time points (Fig. 3).

Fig. 3
figure 3

Incidence of moderate-to-severe pain on movement and at rest. By Bonferroni adjustment, a: Group SM vs. group C, P < 0.05; b: Group SM vs. group S, P < 0.05

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Moreover, group SM slightly reduced NRS scores on movement (3.0 [3.0] vs. 3.0 [2.0] vs. 3.0[1.0]; P < 0.001) and at rest (3.0 [2.0] vs. 2.0 [1.0] vs. 2.0[1.0]; P = 0.030) at postoperative 24 h compared with group C and group S. Group SM also reduced NRS scores on movement at 48 h postoperatively (2.0 [1.0] vs. 2.0 [1.0] vs. 2.0 [1.0]; P = 0.017). However, at other time points, movement and resting NRS scores were similar (Fig. 4).

Fig. 4
figure 4

NRS scores on movement and at rest. By Bonferroni adjustment, a: Group SM vs. group C, P < 0.05; b: Group SM vs. group S, P < 0.05

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In addition, the effective analgesia time of group SM was significantly longer than that of group C and group S (1500.0 [785.0] vs. 915.0 [366.5] vs. 1073.0 [668.5]; P<0.001). Group SM consumed more opioids within 24 h postoperatively (26.0 [6.0] vs. 32.0 [9.0] vs. 28.0 [2.5]; P = 0.004), and fewer people required salvage analgesia (11.1% vs. 48.0% vs. 38.5%; P = 0.009; Table 2).

Table 2 Postoperative analgesic efficacy, adverse reactions and quality of recovery
Full size table

There were no significant differences in adverse effects, including bradycardia, hypotension, hypoxemia, pruritus, wound infection, and hematoma at the puncture site. There was a significant difference in the incidence of nausea and vomiting between the three groups (7.4% vs. 32.0% vs. 30.8%; P = 0.047). One patient of group C developed drowsiness and dizziness (Table 2).

There was also no significant difference in postoperative quality of recovery between the three groups. However, QoR-15 score at 24 h postoperatively, group SM was significantly improved compared with group C and group S (132.0 [10.0] vs. 123.0 [8.0] vs. 127.5 [10.8]; P < 0.001; Table 2).

Discussion

In this randomized controlled trial, we demonstrated that intravenous dexamethasone with dexmedetomidine after erector spinae plane block and serratus anterior plane block could further decreased the incidence of moderate-to-severe pain. It also reduced NRS scores and opioid consumption, lowered the incidence of nausea and vomiting and improved quality of recovery for thoracoscopic surgery.

Possible mechanism of action

Recent years, some studies have shown that both dexamethasone and dexmedetomidine combined with nerve block can improve postoperative pain for thoracoscopic surgery [16]. The potential analgesic effects of glucocorticoids as adjunctive agents may be due to their anti-inflammatory properties, including inhibition of pro-inflammatory factors and induction of anti-inflammatory cytokines, decreased prostaglandin synthesis, and possibly reduced nerve cell excitability [17]. The peripheral analgesic effect of dexmedetomidine may be through the activation of peripheral α2 adrenergic receptors and inhibition of C and Aδ fibers of peripheral nerves, and the central analgesic effect involves nerve remodeling of the dorsal horn of the spinal cord and regulation of NMDA receptors [18]. The mechanism of action of the two drugs are different, generally, the effects of combining the two may be found to be additive, subadditive or supra-additive (i.e.synergistic) [11].

Analgesic efficacy compared with previous studies

This trial chose the incidence of moderate-to-severe pain on movement at 24 h postoperatively as the primary outcome. Reducing it can effectively lower the occurrence of postoperative complications and chronic pain, and promote the rapid recovery of patients, which is a close to clinical and meaningful indicator [19]. The incidence of moderate-to-severe pain after thoracoscopic surgery is about 55% [20–21], and nerve block techniques can significantly reduce it to about 30% [22]. The results of this study showed that intravenous dexamethasone with dexmedetomidine after erector spinae plane block and serratus anterior plane block further reduced it to 11.1%, which reached the desired target. The less invasive technique of local analgesia is a common analgesic measure after thoracoscopic surgery. Wu Z et al. [23] used paravertebral nerve block, and the incidence of moderate-to-severe pain after thoracoscopic surgery was 26.1%. Zhang A et al. [24] added S-ketamine to the self-controlled analgesia of patients undergoing thoracoscopic surgery, and the incidence of moderate-to-severe pain in the early postoperative period was only reduced to 35.8%. In this study, a multimodal regimen of regional analgesia combined with intravenous analgesia was used to significantly control the incidence of moderate-to-severe postoperative pain. In addition, the postoperative NRS scores on movement and at rest in this trial were both reduced by 1, achieving a minimal clinical difference [25]. That is, patients perceived the improvement in postoperative pain as clinically significant.

Kang RA et al. [11] did a study about the effect of intravenous infusion of dexamethasone with dexmedetomidine on the analgesic effect of brachial plexus block in patients undergoing shoulder arthroscopic surgery, and the results showed that the time to first salvage analgesia was up to 66 h, which could not be explained by individual pharmacokinetic properties, unless their combination showed a synergistic effect. The result of our study did not observe such a significant effective analgesic duration, which was about 20 h. The reason may be that the surgeries were different, and thoracoscopic surgery was chosen in this study, which was more painful than shoulder arthroscopic surgery, leading to a shorter duration of analgesia. It was also possible that the definitions of effective analgesia were different, which was defined as the time from the onset of the block to the first postoperative use of salvage analgesics, while we defined it as the time between the onset of the block and the first postoperative compression of the analgesic pump, and the time to the outcome of this study would have been earlier. After further analysis, we found that the more likely cause was that Kang RA et al. [11] started PCIA analgesia when the patient had a VAS score of more than 2 point at rest and celecoxib 200 mg orally every 12 h after surgery, this overly complete multimodal analgesia may have resulted in significant pain in the control group, while the mixed group was treated with analgesia at the time when it should have been painful, which led to a significant prolongation in his primary outcome measure. Hong B et al. [26] showed that the analgesic time was not much longer after using dexamethasone with dexmedetomidine, but slightly shorter than in our study, which was 13.2 h. This may be due to the fact that the outcome measure was the time to onset of pain after surgery. Dexamethasone can prolong the analgesic time of nerve block for about 6 h, dexmedetomidine for about 4 h [2], and the combined use could be extended for about 9 h. The effect of use can be explained by additive, which is more in line with the drug interaction to a certain extent. At the same time, the combination regimen consumed fewer opioids, and although it did not achieve minimal clinical differences which is 10 mg difference in morphine equivalent [27], the number of people who treated them for salvage analgesia was significantly reduced (11.1% vs. 48.0 vs. 38.5%).

Other strengths

There were no significant differences in adverse effects, including bradycardia, hypotension, hypoxemia, pruritus, wound infection, and hematoma at the puncture site. One patient of control group developed drowsiness and dizzines, but after symptomatic treatment, it naturally improved after one day of observation. Beloeil [28] studied that intravenous dexmedetomidine predisposed to cause hypotension and bradycardia, but it was not found in this study. The reason may be that this trial used a low-dose, low-rate intravenous infusion of dexmedetomidine, which greatly avoided the occurrence of adverse reactions [29]. In addition, a significant reduction in the incidence of postoperative nausea and vomiting was found in patients in dexamethasone with dexmedetomidine group, which may be related to the reduction of opioids after the enhanced analgesic effect [30]. It may also be related to dexamethasone being anti-inflammatory and releasing endorphins, dexmedetomidine decreasing sympathetic activity and catecholamine release, thus directly reducing the incidence of postoperative nausea and vomiting [31–32].

There was a significant difference in QoR-15 score at 24 h after surgery, reaching the minimum clinical difference, which is 6 [33]. That means patients in dexamethasone with dexmedetomidine group have better quality of recovery at postoperative 24 h, which is of great clinical significance. This may be due to a reduction in pain, nausea and vomiting, resulting in a faster and better recovery. However, there were no significant differences in other postoperative recovery, including time to first feeding, first bed exit, chest drain removal, and length of hospital stay, possibly because the surgeon followed the protocol and equally treated the patients.

Limitations

There were still some limitations to this study. First, the mixed effects of the two drugs and two nerve blocks still needs to be further studied to understand the underlying mechanism of action and long-term effects (beyond 48 h). Second, we only chose a little dose of dexamethasone and dexmedetomidine, it lacks the dose-response studies and comparisons with alternative drug combinations. Finally, this is a single-center, small-sample study that still needs to be validated in more clinical centers and with larger samples.

Conclusions

This randomized controlled trial showed that intravenous administration of dexamethasone with dexmedetomidine after erector spinae plane block and serratus anterior plane block further decreased the incidence of moderate-to-severe pain. It also reduced NRS scores and opioid consumption, lowered the incidence of nausea and vomiting and improved quality of recovery for thoracoscopic surgery.

Data availability

All data generated or analyzed during this study were included in the published article. Further inquiries about the datasets can be available from the corresponding authors on reasonable request.

Abbreviations

ASA:

American Society of Anaesthesiologists

BMI:

Body mass index

ECG:

Electrocardiogram

HR:

Heart rate

IBP:

Invasive blood pressure

SpO2 :

Peripheral capillary oxygen saturation

BIS:

Bispectral index

PACU:

Post-anesthetic care unit

PCIA:

Patient-controlled intravenous analgesia

NRS:

Numerical rating scale

QoR-15:

Quality of recovery scale-15

NMDA:

N-methyl-D-aspartate

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Acknowledgements

None.

Funding

This study was financially supported by Xuzhou Municipal Health Commission Science and Technology Project (XWKYHT20230056) and Xuzhou Medical University, School of Anesthesiology Clinical Research Project (XYMZ2023009).

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Author notes

  1. Li Zhang, Zhibiao Xu and Yuyun Liu contributed equally to this work.

Authors and Affiliations

  1. Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China

    Li Zhang, Zhibiao Xu, Yuyun Liu, Zijie Ling, Sumin Yuan & Yuxiang Meng

  2. Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai Road, Quanshan District, Xuzhou City, 221002, China

    Li Zhang, Zhibiao Xu, Yuyun Liu, Zijie Ling, Sumin Yuan, Yuxiang Meng, Ziwei Li, Shoujie Feng, Su Liu & Linlin Zhao

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  1. Li Zhang
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Contributions

The study was supported by Linlin Zhao and Su Liu, and was fully participated and managed by Li Zhang, Zhibiao Xu and Yuyun Liu. Zijie Ling, Sumin Yuan and Yuxiang Meng collected the datas. Ziwei Li was responsible for the whole process of anesthesia, and Shoujie Feng was in charge of the operation. All authors contributed equally to the manuscript and read and approved the final version of the manuscript.

Corresponding author

Correspondence to Linlin Zhao.

Ethics declarations

Ethics approval and consent to participate

This is a double-blind, prospective randomized controlled trial conducted from May 16, 2024 to July 31, 2024 at the Affiliated Hospital of Xuzhou Medical University. The study was approved by the Ethics Committee of The Affiliated Hospital of Xuzhou Medical University (XYFY2024-KL193-01) and was registered at the Chinese Clinical Trial Registry (ChiCTR2400084435; registration date: May 16, 2024). All subjects were provided with written informed consent to participate in this study and all experiments were performed in accordance with relevant guidelines and regulations.

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Not Applicable.

Competing interests

The authors declare no competing interests.

CONSORT guidelines

Our study fully adhered to CONSORT guidelines.

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Zhang, L., Xu, Z., Liu, Y. et al. Improvement in postoperative pain control by combined use of intravenous dexamethasone with dexmedetomidine after erector spinae plane block and serratus anterior plane block for thoracoscopic surgery: a randomized controlled trial. BMC Anesthesiol 25, 171 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12871-025-03039-5

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12871-025-03039-5

Keywords

BMC Anesthesiology

ISSN: 1471-2253

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