DEXMEDETOMIDINE reduced epidural analgesic use after VATS lobectomy while improving early pain control and patient satisfaction.
The prospective, randomized, double-blind study enrolled 68 patients undergoing elective video-assisted thoracoscopic (VATS) lobectomy. Of these, 61 were included in the final analysis, comprising 31 patients who received dexmedetomidine and 30 who received saline.
All patients underwent standardized general anesthesia combined with thoracic epidural blockade. The dexmedetomidine group received an intravenous loading dose of 1.0 μg/kg over 10 minutes, followed by an infusion of 0.5 μg/kg/hour until 1 hour after surgery. The control group received a volume-matched saline infusion.
Patient characteristics, anesthesia duration, surgery duration, one-lung ventilation duration, and intraoperative ventilatory parameters were comparable between groups.
Cumulative patient-controlled epidural analgesia consumption was significantly lower with dexmedetomidine across the study period. At 1 hour, mean consumption was 9.58 mL with dexmedetomidine versus 18.8 mL with saline. The difference remained significant at 6, 24, and 48 hours.
By 48 hours, cumulative consumption reached 57.61 mL in the dexmedetomidine group and 73.1 mL in the control group. Patients receiving dexmedetomidine also required fewer rescue analgesic boluses in the post-anesthesia care unit.
Overall postoperative pain scores did not differ significantly between groups across 48 hours. However, pain measured using the visual analog scale was lower with dexmedetomidine at 1 hour after surgery, with scores of 5.52 versus 6.3.
Intraoperative rocuronium requirements were also lower among patients receiving dexmedetomidine. Patient satisfaction was significantly higher in this group.
Bradycardia at 1 hour after surgery and hypotension at 1 hour after one-lung ventilation occurred more frequently with dexmedetomidine. Heart rate and systolic blood pressure were also lower than in the control group.
Rates of nausea, vomiting, shivering, and respiratory depression did not differ significantly between groups. Other measured vital parameters were also comparable.
The findings support perioperative dexmedetomidine as a potential analgesic-sparing adjunct for patients receiving combined epidural and general anesthesia during VATS lobectomy. However, the increased frequency of transient bradycardia and hypotension highlights the need for careful hemodynamic monitoring.
Reference
Lee D et al. Effect of Dexmedetomidine on Postoperative Analgesia After Video-assisted Thoracoscopic Lobectomy Surgery. Int J Med Sci. 2026;23(9):2874–2883.
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