Effect of Dexmedetomidine on Postoperative Analgesia After Video-assisted Thoracoscopic Lobectomy Surgery.

BACKGROUND: Dexmedetomidine is a highly selective α2-adrenergic receptor agonist that provides sedative and analgesic effects and may reduce opioid requirements without significant respiratory depression. However, evidence supporting its use in patients undergoing video-assisted thoracoscopic (VATS) lobectomy remains limited. This study aimed to evaluate the effects of perioperative dexmedetomidine on postoperative analgesic requirements and recovery outcomes in patients receiving combined epidural and general anesthesia. MATERIALS AND METHODS: This prospective, randomized, double-blind study enrolled 68 patients undergoing elective VATS lobectomy. Patients were randomly assigned to the dexmedetomidine group (Group D) or the saline control group (Group S). All patients received standardized general anesthesia combined with thoracic epidural blockade. Group D received an intravenous loading dose of dexmedetomidine (1.0 μg/kg over 10 minutes), followed by a continuous infusion at 0.5 μg/kg/h until 1 hour after surgery, whereas Group S received a volume-matched saline infusion. The primary outcome was total patient-controlled epidural analgesia (PCEA) consumption. Secondary outcomes included visual analog scale (VAS) scores, Ramsay sedation scores, adverse events, and patient satisfaction assessed over 48 hours postoperatively. RESULTS: Sixty-one patients were included in the final analysis (Group D, n = 31; Group S, n = 30). Baseline demographic and intraoperative characteristics were comparable between groups. Intraoperative rocuronium requirements, cumulative patient-controlled epidural analgesia (PCEA) consumption from the intraoperative period to 48 hours postoperatively, and the number of rescue analgesic boluses administered in the post-anesthesia care unit were significantly lower in Group D than in Group S (p = 0.002, 0.001, and 0.013, respectively). Although overall postoperative pain scores were comparable between groups, VAS scores at 1 hour postoperatively were significantly lower in Group D (p = 0.038). Patient satisfaction scores were significantly higher in Group D (p = 0.005). Bradycardia 1 hour after surgery and hypotension 1 hour after one-lung ventilation occurred more frequently in Group D (p = 0.044 and 0.024, respectively), whereas the incidence of other adverse events was similar between groups. CONCLUSIONS: Perioperative dexmedetomidine infusion reduced postoperative epidural analgesic requirements and improved early postoperative pain control and patient satisfaction in patients undergoing VATS lobectomy with combined epidural and general anesthesia. Despite an increased incidence of transient bradycardia and hypotension, dexmedetomidine was well tolerated and may be considered an effective opioid-sparing adjunct in this surgical population.