High-Thoracic ESPB Technique [
bradycardia, pain, hypotension, NRS, nausea, vomiting
EVENTS
Blocks were put together using a US machine (Philips CX50 Extreme edition). To see the lateral tip of the T2 transversal process, a 2–5 MH2 curved probe was positioned transversely. The patient's transducer was positioned longitudinally three cm laterally of the T2 spinous process. The hyperechoic transverse process cast a shadow across the muscles of the rhomboid major, trapezius, and erector spinae. The skin was thereafter numbed with 3 ml of 2% lidocaine. A 20-gauge needle was used to administer 20 ml of 0.25% bupivacaine or 19 ml of bupivacaine 0.25% + 1 mL of 0.5 g/kg dexmedetomidine to the designated group. The tip of the needle was positioned in the deep fascial plane (anterior) side of the erector spinae. The fluid spreading out, lifting the erector spinae muscle away from the transverse process shadow, revealed the needle's position.The success of the block was confirmed by the loss of pinprick sensation on the dermatomal site of the block after 30 min of injection. Therefore, cases of failed blocks were excluded from the study.The conventional approach of GA was used in every case. Monitoring was done by pulse oximetry, noninvasive blood pressure, temperature probe, capnography, and 5- lead ECG. Propofol 2 mg/kg IV and fentanyl one µg/kg IV were used to induce GA. Cis-atracurium 0.15 mg/kg IV was used to facilitate endotracheal intubation. Isoflurane 1–1.5% in 50% oxygen was used for anesthesia maintenance. Increasing dosages of 0.03 mg/kg cis-atracurium were administered intravenously. The depth of anesthesia was adjusted to obtain an adequate level of anesthesia by titrating the concentration according to the BIS monitoring (BIS Complete Monitoring System) to keep the BIS value between 40 and 60. Supplemental dosages of fentanyl one µg/kg IV were administered whenever the mean arterial blood pressure (MAP) or heart rate (HR) was over 20% from baseline readings. Intraoperative fentanyl (including induction dose) and isoflurane consumption were recorded. Intraoperative HR and MAP were measured intraoperatively every 15 min.The extubation was completed once the anaesthesia was stopped. The post-anesthesia care unit received the cases (PACU). After then, cases were moved to the ward. Cases received a 1 gm/8 h IV dose of paracetamol. If the numeric rating scale (NRS) score is ≥ 4, rescue analgesia in the form of 3 mg IV morphine was administered. This procedure was repeated with a 10-min lockout interval until the NRS value dropped below 3. It was noted when the first rescue analgesia was used and how much morphine was used overall in the first day after surgery. In the PACU, immediately after surgery, and at 1, 2, 4, 6, 8, 12, and 24 h postoperatively, pain was assessed using the numerical rating scale (NRS), HR, and MAP.Adverse events were recorded, such as nausea, vomiting, and hypotension (MAP < 20% of baseline readings and was managed by ephedrine, bradycardia (HR < 60 beats/min and was managed by atropine).