Dexmedetomidine as an Adjuvant to Ropivacaine in Thoracic Paravertebral Block: A Systematic Review with Meta-analysis

Abstract

Background: One of the ongoing challenges in thoracic surgeries, especially video-assisted thoracoscopic surgery (VATS), is effective postoperative pain management. The thoracic paravertebral block (TPVB) using ropivacaine provides targeted analgesia but suffers from a limited duration of effect. This meta-analysis aims to assess the safety of combining dexmedetomidine with ropivacaine in TPVB for thoracic procedures and to explore potential analgesic benefits suggested by individual trials. Method: A systematic review and meta-analysis of randomized controlled trials were conducted to compare the combination of dexmedetomidine and ropivacaine (PRD) with ropivacaine alone (PR) in thoracic procedures. Outcomes assessed included adverse effects (bradycardia, dizziness, hypotension, nausea, and vomiting). Analgesic and opioid-sparing effects were reported narratively, as data were heterogeneous and unsuitable for pooled analysis. Result: Five studies were included. No statistically significant differences were found between PRD and PR in the incidence of bradycardia (RR: 2.14; 95% CI: 0.71–6.40; p=0.1750), dizziness (RR: 1.52; 95% CI: 0.71–3.27; p=0.2833), hypotension (RR: 0.78; 95% CI: 0.40–1.53; p=0.4676), nausea (RR: 1.15; 95% CI: 0.65–2.03; p=0.6018), or vomiting (RR: 1.04; 95% CI: 0.54–2.02; p=0.9122). Some individual trials suggested reduced postoperative pain scores and opioid use with dexmedetomidine, but these findings could not be synthesized quantitatively. Conclusion: Adding dexmedetomidine to ropivacaine in TPVB for thoracic surgery appears safe, with no significant increase in adverse effects. While some individual trials indicated potential analgesic and opioid-sparing benefits, these results remain heterogeneous and cannot be confirmed by pooled evidence. Further high-quality, standardized trials are needed.