{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T16:14:26Z","timestamp":1774973666600,"version":"3.50.1"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,25]],"date-time":"2021-11-25T00:00:00Z","timestamp":1637798400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> The anesthetic characteristics of ultrasound-guided bi-level erector spinae plane block (ESPB) plus dexmedetomidine (Dex) remain unclear. We compared the efficacy and safety of ultrasound-guided bi-level ESPB plus different doses of Dex in patients undergoing video-assisted thoracic surgery (VATS).<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> One-hundred eight patients undergoing VATS were randomized into three groups: R group (<jats:italic>n<\/jats:italic> = 38, 15 ml of 0.375% ropivacaine with 0.1 mg\/kg dexamethasone), RD1 group (<jats:italic>n<\/jats:italic> = 38, 15 ml of 0.375% ropivacaine plus 0.5 \u03bcg\/kg DEX with 0.1 mg\/kg dexamethasone) and RD2 group (<jats:italic>n<\/jats:italic> = 38, 15 ml of 0.375% ropivacaine plus 1.0 \u03bcg\/kg DEX with 0.1 mg\/kg dexamethasone). The primary outcome was the pain 12 h after surgery. Secondary outcomes included the Prince Henry Hospital Pain Score; hemodynamics; consumption of sufentanil; anesthetized dermatomal distribution; recovery time; rescue analgesia; satisfaction scores of patients and surgeon; quick recovery index; adverse effects; the prevalence of chronic pain and quality of recovery.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The visual analog scale (VAS) and the Prince Henry pain score were significantly lower in both the RD1 and RD2 groups during the first 24 h after surgery (<jats:italic>P<\/jats:italic> \n&amp;lt; 0.05). Both VAS with coughing and the Prince Henry pain score were significantly lower in the RD2 group than in the RD1 group 8\u201324 h after surgery (<jats:italic>P<\/jats:italic> &amp;lt; 0.05). Both heart rate and mean arterial pressure were significantly different from T2 to T6 in the RD1 and RD2 groups (<jats:italic>P<\/jats:italic> &amp;lt; 0.05). The receipt of remifentanil, propofol, Dex, and recovery time was significantly reduced in the RD2 group (<jats:italic>P<\/jats:italic> &amp;lt; 0.05). The requirement for sufentanil during the 8\u201372 h after surgery, less rescue medication, and total press times were significantly lower in the RD2 group (<jats:italic>P<\/jats:italic> &amp;lt; 0.05). The time to the first dose of rescue ketorolac was significantly longer in the RD2 group (<jats:italic>P<\/jats:italic> &amp;lt; 0.05). Further, anal exhaust, removal of chest tubes, and ambulation were significantly shorter in the RD2 group (<jats:italic>P<\/jats:italic> &amp;lt; 0.05). The incidence of tachycardia, post-operative nausea and vomiting, and chronic pain was significantly reduced in the RD2 group, while the QoR-40 score was significantly higher in the RD2 group (<jats:italic>P<\/jats:italic> &amp;lt; 0.05).<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Pre-operative bi-level, single-injection ESPB plus 1 \u03bcg\/kg DEX provided superior pain relief and long-term post-operative recovery for patients undergoing VATS.<\/jats:p><jats:p><jats:bold>Clinical Trial Registration:<\/jats:bold><jats:ext-link>http:\/\/www.chictr.org.cn\/searchproj.aspx<\/jats:ext-link>.<\/jats:p>","DOI":"10.3389\/fmed.2021.577885","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T23:50:39Z","timestamp":1638316239000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":21,"title":["The Efficacy and Safety of Ultrasound-Guided, Bi-Level, Erector Spinae Plane Block With Different Doses of Dexmedetomidine for Patients Undergoing Video-Assisted Thoracic Surgery: A Randomized Controlled Trial"],"prefix":"10.3389","volume":"8","author":[{"given":"Xiujuan","family":"Gao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tonghang","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guangjun","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunguang","family":"Ren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guoying","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ke","family":"Du","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1093\/ejcts\/ezy301","article-title":"Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS1) Society and the European Society of Thoracic Surgeons (ESTS)","volume":"55","author":"Batchelor","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"S555","DOI":"10.21037\/jtd.2017.12.86","article-title":"Enhanced recovery pathways in thoracic surgery from Italian VATS group: perioperative analgesia protocols","author":"Piccioni","year":"2018","journal-title":"J Thorac Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/j.jtcvs.2015.05.057","article-title":"Symptom recovery after thoracic surgery: measuring patient-reported outcomes with the MD Anderson symptom inventory","volume":"150","author":"Fagundes","year":"2015","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1097\/ALN.0000000000001576","article-title":"A prospective study of chronic pain after thoracic surgery","volume":"126","author":"Bayman","year":"2017","journal-title":"Anesthesiology"},{"key":"B5","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/j.ejcts.2009.02.005","article-title":"Chronic post-thoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention","volume":"36","author":"Wildgaard","year":"2009","journal-title":"Eur J Cardiothorac Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1093\/bja\/aew269","article-title":"Thoracic paravertebral blocks in abdominal surgery - 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