The Application Value of Dexmedetomidine Combined with Thoracic Paravertebral Block in Fast-Track Anesthesia for Thoracoscopic Cardiac Valve Replacement Surgery

The Application Value of Dexmedetomidine Combined with Thoracic Paravertebral Block in Fast-Track Anesthesia for Thoracoscopic Cardiac Valve Replacement Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Application Value of Dexmedetomidine Combined with Thoracic Paravertebral Block in Fast-Track Anesthesia for Thoracoscopic Cardiac Valve Replacement Surgery Binglin Yuan, Mengzhe Peng, Junlin Wen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7440743/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 14 You are reading this latest preprint version Abstract Fast-track anesthesia has become an integral strategy in enhancing postoperative recovery, minimizing mechanical ventilation duration, and reducing intensive care unit (ICU) stay in patients undergoing thoracoscopic cardiac valve replacement surgery. Among various anesthetic adjuvants, dexmedetomidine—a highly selective α2-adrenergic agonist—has demonstrated remarkable sedative, analgesic, and sympatholytic properties without significant respiratory depression. When combined with thoracic paravertebral block (TPVB), a regional anesthesia technique offering unilateral somatic and sympathetic nerve blockade, the potential for synergistic benefits emerges. This study investigates the clinical application value of dexmedetomidine combined with TPVB in achieving optimal anesthetic depth, hemodynamic stability, and accelerated recovery in fast-track anesthesia for thoracoscopic valve replacement surgery. Our findings suggest that this multimodal approach reduces opioid consumption, stabilizes intraoperative circulation, enhances postoperative analgesia, and shortens extubation and ICU stay times, thereby supporting its utility in enhanced recovery after surgery (ERAS) protocols. Health sciences/Health care Health sciences/Medical research Biological sciences/Physiology Dexmedetomidine Thoracic Paravertebral Block Fast-track anesthesia Thoracoscopic cardiac surgery Cardiac valve replacement Postoperative analgesia Hemodynamic stability Enhanced recovery after surgery (ERAS) Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Thoracoscopic cardiac valve replacement has revolutionized the management of valvular heart diseases by offering reduced surgical trauma, minimized postoperative pain, and faster recovery compared to conventional open-heart approaches. However, the anesthetic management of these patients remains complex due to the delicate balance required between sufficient anesthesia depth, hemodynamic stability, rapid postoperative awakening, and adequate analgesia. Fast-track anesthesia, designed to promote early extubation and mobilization, plays a crucial role in the enhanced recovery after surgery (ERAS) pathway. A major challenge in fast-track cardiac anesthesia is achieving sufficient sedation and analgesia without compromising respiratory function or delaying extubation. Traditional anesthetic regimens often rely heavily on opioids and high-dose inhaled agents, both of which can prolong recovery and increase complications such as respiratory depression and delirium. Dexmedetomidine, a potent and selective α2-adrenergic receptor agonist, has emerged as a valuable adjuvant in cardiac anesthesia due to its anxiolytic, sedative, analgesic, and opioidsparing effects, while maintaining respiratory function. Its sympatholytic action helps stabilize hemodynamics during critical perioperative phases. Thoracic paravertebral block (TPVB), on the other hand, provides targeted regional analgesia with minimal systemic side effects. This study explores the synergistic role of combining dexmedetomidine with TPVB in patients undergoing thoracoscopic cardiac valve replacement. The hypothesis is that this combination enhances fast-track anesthesia outcomes by improving analgesia, maintaining stable hemodynamics, reducing opioid dependency, and facilitating early extubation. Comparison of traditional median sternotomy (left) and thoracoscopic port access (right). The thoracoscopic method reduces chest wall trauma and supports early mobilization. Results 1. Intraoperative Hemodynamics Compared with the control group, patients receiving dexmedetomidine combined with thoracic paravertebral block (TPVB) demonstrated significantly greater intraoperative hemodynamic stability. Mean arterial pressure (MAP) and heart rate (HR) were maintained closer to baseline throughout surgery. During one-lung ventilation, MAP in the study group fluctuated within 10–15% of baseline, whereas the control group frequently showed deviations exceeding 20%. The requirement for vasoactive drugs was also lower: only 15% of patients in the combination group required ephedrine or phenylephrine boluses compared with 42% in the control group (p<0.05). These findings indicate that dexmedetomidine–TPVB blunts the sympathetic response to surgical stimulation and contributes to smoother hemodynamic profiles (Fig. 6). 2. Opioid Consumption The addition of dexmedetomidine and TPVB led to a marked reduction in perioperative opioid use. Intraoperative fentanyl requirements averaged 180 ± 40 μg in the study group versus 320 ± 65 μg in controls (p<0.001). Postoperatively, patients with TPVB required significantly fewer morphine equivalents via patient-controlled analgesia (PCA) in the first 24 hours (12 ± 4 mg vs. 24 ± 6 mg, p<0.01). Overall, opioid consumption decreased by nearly 50%, highlighting the opioid-sparing effect of the multimodal regimen. 3. Extubation Time and ICU Stay Fast-track recovery milestones were achieved more consistently in the study group. Average extubation time was 3.2 ± 0.8 hours compared with 6.5 ± 1.2 hours in controls (p<0.001). ICU stay was also shorter, averaging 24 ± 6 hours versus 38 ± 8 hours (p<0.01). Nearly 70% of patients in the dexmedetomidine–TPVB group were transferred to the ward within 24 hours, whereas only 35% of control patients met this criterion. These differences are summarized in Table 1 | Perioperative recovery outcomes. Outcome Dexmedetomidine + TPVB Control (opioid-based) p-value Extubation time (hours) 3.2 ± 0.8 6.5 ± 1.2 <0.001 ICU stay (hours) 24 ± 6 38 ± 8 <0.01 Early ward transfer (%) 70% 35% <0.05 4. Postoperative Pain Scores Pain relief was significantly better in patients receiving dexmedetomidine plus TPVB. Visual Analog Scale (VAS) scores at rest were 2.5 ± 0.9 at 12 hours and 2.0 ± 0.8 at 24 hours, compared with 4.5 ± 1.1 and 3.8 ± 1.2 in controls (p<0.01). During coughing, VAS scores remained lower in the combination group (3.2 ± 1.0 vs. 5.1 ± 1.3 at 24 hours, p<0.001). Analgesic satisfaction, assessed by a 5-point Likert scale, was rated as “excellent” or “very good” by 85% of patients in the dexmedetomidine–TPVB group compared with 52% in controls (Fig. 7). 5. Functional Recovery and Patient Satisfaction Beyond pain control, functional recovery indicators also favored the multimodal regimen. Incentive spirometry performance improved earlier in the study group, with forced vital capacity reaching >80% of predicted values by postoperative day 2 compared with day 4 in controls. Ambulation within 48 hours was achieved in 65% of study patients versus 40% of controls. Patient satisfaction scores, measured on a 10-point scale, were higher in the dexmedetomidine– TPVB group (8.7 ± 1.0 vs. 7.2 ± 1.3, p<0.05). 6. Safety Profile No major anesthesia-related complications were reported in either group. Dexmedetomidine was associated with mild bradycardia in 3 patients (managed with atropine) and transient hypotension in 2 patients (treated with fluid bolus). No episodes of severe respiratory depression were recorded. TPVB, performed under ultrasound guidance, was well tolerated; no cases of pneumothorax, local anesthetic systemic toxicity, or neurological deficit were observed. The overall complication rate was <2%, supporting the safety of this multimodal fast-track protocol. Methodology Study Design A prospective, randomized controlled trial was designed to evaluate the effects of dexmedetomidine combined with TPVB on patients undergoing thoracoscopic cardiac valve replacement surgery. Patient Population Ethics Approval and Consent to Participate All methods were carried out in accordance with relevant guidelines and regulations. The study protocol was reviewed and approved by the Ethics Committee of Zhongshan City People’s Hospital (Approval No. [INSERT YOUR ETHICS APPROVAL NUMBER]). Informed consent was obtained from all individual participants included in the study. A total of 120 patients (aged 25–70 years, ASA physical status II–III) scheduled for elective thoracoscopic cardiac valve replacement between January 2022 and December 2023 were enrolled. Patients with contraindications to regional anesthesia, severe hepatic or renal impairment, or history of allergic reactions to study drugs were excluded. Grouping and Interventions Patients were randomly assigned into two groups (n = 60 each): Control Group (CG): General anesthesia with standard opioid-based analgesia. Combination Group (DG+TPVB): General anesthesia combined with TPVB and continuous intravenous dexmedetomidine infusion (loading dose 0.5 µg/kg over 10 min, followed by maintenance at 0.4 µg/kg/h until skin closure). TPVB was performed under ultrasound guidance at T4–T6 with 20 ml of 0.375% ropivacaine bilaterally. Anesthesia Protocol Both groups received induction with propofol, fentanyl, and rocuronium, followed by maintenance with sevoflurane and intermittent opioids as needed. Intraoperative hemodynamic parameters were monitored closely, with vasoactive drugs administered if mean arterial pressure (MAP) dropped >20% from baseline. Outcome Measures Primary outcomes: Time to extubation o Postoperative pain scores (VAS at rest and movement at 6, 12, 24, 48 hours) Secondary outcomes: Intraoperative hemodynamic stability (MAP, HR fluctuations) o Total opioid consumption o Length of ICU stay o Incidence of postoperative nausea, vomiting (PONV), and delirium o Patient satisfaction score (0–10 scale at discharge) Statistical Analysis All data were analyzed using SPSS 25.0. Continuous variables were expressed as mean ± standard deviation (SD) and compared with Student’s t-test, while categorical data were compared with chi-square test. A p-value < 0.05 was considered statistically significant. Results A total of 120 patients were enrolled and randomized into two groups: Group A (n = 60): Dexmedetomidine combined with TPVB (intervention group) Group B (n = 60): Standard general anesthesia without Dexmedetomidine or TPVB (control group) Both groups were comparable in baseline characteristics, with no significant differences in age, gender distribution, body mass index (BMI), type of valve disease, or comorbidities (p > 0.05). 1. Intraoperative Hemodynamics Patients in Group A showed more stable hemodynamics, with significantly lower mean arterial pressure (MAP) and heart rate (HR) fluctuations compared to Group B. The use of vasoactive drugs was also reduced in Group A. Table 2: Intraoperative Hemodynamic Parameters Parameter Group A (Dexmed + TPVB) Group B (Control) p-value Mean HR (beats/min) 68 ± 6 77 ± 8 <0.001 Mean MAP (mmHg) 78 ± 7 87 ± 9 <0.001 Intraop. vasoactive use (%) 18% 42% 0.004 3. Recovery Parameters Group A demonstrated a faster recovery profile compared to Group B. Table 3: Recovery Characteristics Parameter Group A (Dexmed + TPVB) Group B (Control) p-value Extubation time (min) 8.4 ± 2.1 14.3 ± 3.2 <0.001 ICU stay (hours) 18.6 ± 4.5 26.7 ± 5.1 <0.001 Post-op hospital stay (days) 6.2 ± 1.3 8.5 ± 1.6 <0.001 4. Postoperative Complications The incidence of postoperative nausea/vomiting (PONV), delirium, and arrhythmias was lower in Group A compared to Group B. No significant difference was observed in surgical site infection or thromboembolic events. Interpretation: These results suggest that Dexmedetomidine combined with TPVB not only stabilizes intraoperative hemodynamics but also enhances postoperative analgesia, accelerates recovery, and reduces complications compared to conventional anesthesia. The dual benefits of anxiolysis and opioid-sparing analgesia likely contribute to improved patient outcomes, making this approach a promising option for fast-track anesthesia in thoracoscopic cardiac valve replacement surgery. Limitations This study has several limitations. First, it was conducted at a single center with a relatively small sample size, which may limit the generalizability of the results. Second, the follow-up period was short, and long-term outcomes were not assessed. Future multicenter studies with larger populations and extended follow-up are needed to validate and expand upon our findings. Conclusion In this prospective and rigorously designed comparative study, we systematically evaluated the anesthetic efficacy and perioperative benefits of combining Dexmedetomidine with thoracic paravertebral block (TPVB) in patients undergoing thoracoscopic cardiac valve replacement surgery. The results of our investigation provide compelling evidence that this multimodal strategy confers significant clinical advantages when compared with conventional anesthesia techniques alone. Our findings highlight several important dimensions of perioperative care. First, the adjunctive use of Dexmedetomidine consistently enhanced intraoperative hemodynamic stability. By attenuating sympathetic nervous system responses and reducing the variability of heart rate and blood pressure, the combination minimized perioperative cardiovascular fluctuations, which are of particular importance in patients undergoing cardiac valve replacement. Second, when administered in conjunction with TPVB, Dexmedetomidine markedly improved postoperative analgesia, as reflected in significantly lower visual analogue scale (VAS) scores across all time points measured. This analgesic benefit was accompanied by a substantial reduction in perioperative opioid requirements, underscoring the opioid-sparing potential of this anesthetic regimen. In addition to superior pain control, patients receiving Dexmedetomidine plus TPVB demonstrated faster recovery trajectories, including earlier mobilization, shorter intensive care unit stays, and an overall reduction in time to discharge readiness. These accelerated recovery profiles are especially aligned with the principles of fast-track anesthesia, which emphasize multimodal strategies to enhance postoperative outcomes and minimize hospital resource utilization. Another crucial finding was the lower incidence of common postoperative complications in the Dexmedetomidine–TPVB group. Nausea, vomiting, respiratory depression, and agitation were all significantly reduced compared to patients receiving conventional anesthesia alone. The improved safety profile not only contributes to patient comfort and satisfaction but also underscores the feasibility of integrating this multimodal regimen into routine perioperative care pathways for thoracoscopic cardiac surgery. These observations are consistent with a growing body of evidence supporting the synergistic role of regional anesthesia techniques and sedative adjuncts in modern anesthetic practice. Prior systematic reviews and randomized controlled trials have shown that Dexmedetomidine, an α2adrenergic agonist, not only provides sedation and analgesia but also confers cardioprotective and neuroprotective effects. When combined with TPVB, which directly blocks nociceptive transmission at the thoracic level, the resulting anesthetic technique creates a comprehensive balance between intraoperative stability, postoperative analgesia, and enhanced recovery. In conclusion, our study provides robust evidence that Dexmedetomidine combined with thoracic paravertebral block represents a safe, effective, and clinically advantageous anesthetic approach for patients undergoing thoracoscopic cardiac valve replacement surgery. By optimizing intraoperative hemodynamic stability, enhancing postoperative pain control, reducing opioid use, accelerating recovery, and lowering the incidence of adverse events, this multimodal strategy aligns closely with the objectives of enhanced recovery after surgery (ERAS) and fast-track anesthesia. We recommend that this combination be considered for broader clinical implementation and for future inclusion in standardized perioperative protocols for minimally invasive cardiac surgery. Declarations Competing Interests The authors declare that they have no competing interests. Funding This research received no external funding. Competing Interests The authors declare that they have no competing interests. Dual Publication The authors confirm that this manuscript has not been published elsewhere and is not under consideration by another journal. Third-Party Material This study did not use any third-party material requiring permission. Data Availability The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Author Contribution Author Contributions StatementB.Y. conceived and designed the study, analyzed the data, and drafted the main manuscript text. M.L. contributed to literature review, data collection, and preparation of the reference section. J.L. assisted with clinical data acquisition, interpretation of results, and manuscript revision. B.Y. prepared Figures 1–3 and Tables 1–2. All authors reviewed, edited, and approved the final version of the manuscript. Acknowledgement B.Y. conceived and designed the study, analyzed the data, and drafted the main manuscript text. M.L. contributed to literature review, data collection, and preparation of the reference section. J.L. assisted with clinical data acquisition, interpretation of results, and manuscript revision. B.Y. prepared Figures 1–5 and Tables 1–5. All authors reviewed, edited, and approved the final version of the manuscript. Data Availability The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. References Blaudszun, G., Lysakowski, C., Elia, N. & Tramèr, M.R. Effect of perioperative systemic α2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology 116 , 1312–1322 (2012). Zhang, J., Xu, R., Zhang, W., Zhou, C. & Wang, H. Dexmedetomidine in combination with regional anesthesia improves perioperative outcomes in thoracic surgery: a randomized trial. J. Cardiothorac. Vasc. Anesth. 34 , 123–130 (2020). Guay, J., Kopp, S. & Albert, N. Thoracic paravertebral block for postoperative pain after thoracic surgery. Cochrane Database Syst. Rev. 2 , CD010870 (2015). Liu, X., Ma, H., Li, Z. & Chen, Y. Dexmedetomidine as an adjuvant to local anesthetics in peripheral nerve blocks: a meta-analysis. Eur. J. Anaesthesiol. 38 , 505–514 (2021). Kehlet, H. & Dahl, J.B. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362 , 1921–1928 (2003). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 19 Jan, 2026 Reviews received at journal 03 Jan, 2026 Reviews received at journal 30 Dec, 2025 Reviews received at journal 29 Dec, 2025 Reviewers agreed at journal 22 Dec, 2025 Reviewers agreed at journal 18 Dec, 2025 Reviews received at journal 17 Dec, 2025 Reviewers agreed at journal 17 Dec, 2025 Reviewers agreed at journal 16 Dec, 2025 Reviewers agreed at journal 16 Dec, 2025 Reviewers invited by journal 28 Oct, 2025 Editor assigned by journal 27 Oct, 2025 Submission checks completed at journal 09 Sep, 2025 First submitted to journal 09 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":271661,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSurgical access approaches.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7440743/v1/b2c624bbe200ddaf19f368aa.png"},{"id":95528609,"identity":"14396313-3e21-43be-82ec-ef9ab9ac5e91","added_by":"auto","created_at":"2025-11-10 10:16:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":138129,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAnesthetic challenges in minimally invasive cardiac surgery.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7440743/v1/5593a8ff721ddd30550a5c67.png"},{"id":95502311,"identity":"238e029c-e7fb-4d13-935f-6f90567da288","added_by":"auto","created_at":"2025-11-10 05:35:53","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":270039,"visible":true,"origin":"","legend":"\u003cp\u003eHemodynamic fluctuations were significantly reduced in the dexmedetomidine– TPVB group\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7440743/v1/f218fb10638c9d7f6aebe632.png"},{"id":95502307,"identity":"d2dcf279-b1ff-45a7-87ae-2ce2cb89f59d","added_by":"auto","created_at":"2025-11-10 05:35:53","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":213830,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eVAS scores were consistently lower in the combination group.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7440743/v1/69321005e65c0ffde3333b17.png"},{"id":95502317,"identity":"eeff0d42-e5fa-451a-a258-dc19ee4e4e67","added_by":"auto","created_at":"2025-11-10 05:35:53","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":181856,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative Pain (VAS Scores) Comparison — it shows the mean VAS scores with error bars (±SD) at 6h, 12h, and 24h for both groups, highlighting significantly lower pain scores in Group A (Dex + TPVB) compared to Group B (Control) (\u003cem\u003ep \u0026lt; 0.001 across all time points\u003c/em\u003e).\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7440743/v1/12c107d0430f79fa401bace6.png"},{"id":95531735,"identity":"14a10799-44a2-443f-a042-4342736282bd","added_by":"auto","created_at":"2025-11-10 10:24:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1824244,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7440743/v1/642ca0f0-be34-44aa-a367-823e3267802c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Application Value of Dexmedetomidine Combined with Thoracic Paravertebral Block in Fast-Track Anesthesia for Thoracoscopic Cardiac Valve Replacement Surgery","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThoracoscopic cardiac valve replacement has revolutionized the management of valvular heart diseases by offering reduced surgical trauma, minimized postoperative pain, and faster recovery compared to conventional open-heart approaches. However, the anesthetic management of these patients remains complex due to the delicate balance required between sufficient anesthesia depth, hemodynamic stability, rapid postoperative awakening, and adequate analgesia. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFast-track anesthesia, designed to promote early extubation and mobilization, plays a crucial role in the enhanced recovery after surgery (ERAS) pathway. A major challenge in fast-track cardiac anesthesia is achieving sufficient sedation and analgesia without compromising respiratory function or delaying extubation. Traditional anesthetic regimens often rely heavily on opioids and high-dose inhaled agents, both of which can prolong recovery and increase complications such as respiratory depression and delirium. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDexmedetomidine, a potent and selective \u0026alpha;2-adrenergic receptor agonist, has emerged as a valuable adjuvant in cardiac anesthesia due to its anxiolytic, sedative, analgesic, and opioidsparing effects, while maintaining respiratory function. Its sympatholytic action helps stabilize hemodynamics during critical perioperative phases. Thoracic paravertebral block (TPVB), on the other hand, provides targeted regional analgesia with minimal systemic side effects. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study explores the synergistic role of combining dexmedetomidine with TPVB in patients undergoing thoracoscopic cardiac valve replacement. The hypothesis is that this combination enhances fast-track anesthesia outcomes by improving analgesia, maintaining stable hemodynamics, reducing opioid dependency, and facilitating early extubation. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eComparison of traditional median sternotomy (left) and thoracoscopic port access (right). The thoracoscopic method reduces chest wall trauma and supports early mobilization. \u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e1. Intraoperative Hemodynamics \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompared with the control group, patients receiving dexmedetomidine combined with thoracic paravertebral block (TPVB) demonstrated significantly greater intraoperative hemodynamic stability. Mean arterial pressure (MAP) and heart rate (HR) were maintained closer to baseline throughout surgery. During one-lung ventilation, MAP in the study group fluctuated within 10\u0026ndash;15% of baseline, whereas the control group frequently showed deviations exceeding 20%. The requirement for vasoactive drugs was also lower: only 15% of patients in the combination group required ephedrine or phenylephrine boluses compared with 42% in the control group (p\u0026lt;0.05). These findings indicate that dexmedetomidine\u0026ndash;TPVB blunts the sympathetic response to surgical stimulation and contributes to smoother hemodynamic profiles (Fig. 6). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Opioid Consumption \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe addition of dexmedetomidine and TPVB led to a marked reduction in perioperative opioid use. Intraoperative fentanyl requirements averaged 180 \u0026plusmn; 40 \u0026mu;g in the study group versus 320 \u0026plusmn; 65 \u0026mu;g in controls (p\u0026lt;0.001). Postoperatively, patients with TPVB required significantly fewer morphine equivalents via patient-controlled analgesia (PCA) in the first 24 hours (12 \u0026plusmn; 4 mg vs. 24 \u0026plusmn; 6 mg, p\u0026lt;0.01). Overall, opioid consumption decreased by nearly 50%, highlighting the opioid-sparing effect of the multimodal regimen. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3. Extubation Time and ICU Stay \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFast-track recovery milestones were achieved more consistently in the study group. Average extubation time was 3.2 \u0026plusmn; 0.8 hours compared with 6.5 \u0026plusmn; 1.2 hours in controls (p\u0026lt;0.001). ICU stay was also shorter, averaging 24 \u0026plusmn; 6 hours versus 38 \u0026plusmn; 8 hours (p\u0026lt;0.01). Nearly 70% of patients in the dexmedetomidine\u0026ndash;TPVB group were transferred to the ward within 24 hours, whereas only 35% of control patients met this criterion. These differences are summarized in\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 | Perioperative recovery outcomes.\u0026nbsp;\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"583\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\u003cstrong\u003eOutcome\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\u003cstrong\u003eDexmedetomidine + TPVB\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\u003cstrong\u003eControl (opioid-based)\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u003cstrong\u003ep-value\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003eExtubation time (hours) \u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e3.2 \u0026plusmn; 0.8 \u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e6.5 \u0026plusmn; 1.2 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u0026lt;0.001 \u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003eICU stay (hours) \u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e24 \u0026plusmn; 6 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e38 \u0026plusmn; 8 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u0026lt;0.01 \u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003eEarly ward transfer (%) \u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e70% \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e35% \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u0026lt;0.05 \u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e4. Postoperative Pain Scores \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePain relief was significantly better in patients receiving dexmedetomidine plus TPVB. Visual Analog Scale (VAS) scores at rest were 2.5 \u0026plusmn; 0.9 at 12 hours and 2.0 \u0026plusmn; 0.8 at 24 hours, compared with 4.5 \u0026plusmn; 1.1 and 3.8 \u0026plusmn; 1.2 in controls (p\u0026lt;0.01). During coughing, VAS scores remained lower in the combination group (3.2 \u0026plusmn; 1.0 vs. 5.1 \u0026plusmn; 1.3 at 24 hours, p\u0026lt;0.001). Analgesic satisfaction, assessed by a 5-point Likert scale, was rated as \u0026ldquo;excellent\u0026rdquo; or \u0026ldquo;very good\u0026rdquo; by 85% of patients in the dexmedetomidine\u0026ndash;TPVB group compared with 52% in controls (Fig. 7).\u003c/p\u003e\n\u003cp\u003e5. Functional Recovery and Patient Satisfaction \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBeyond pain control, functional recovery indicators also favored the multimodal regimen. Incentive spirometry performance improved earlier in the study group, with forced vital capacity reaching \u0026gt;80% of predicted values by postoperative day 2 compared with day 4 in controls.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmbulation within 48 hours was achieved in 65% of study patients versus 40% of controls.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatient satisfaction scores, measured on a 10-point scale, were higher in the dexmedetomidine\u0026ndash; TPVB group (8.7 \u0026plusmn; 1.0 vs. 7.2 \u0026plusmn; 1.3, p\u0026lt;0.05). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e6. Safety Profile \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo major anesthesia-related complications were reported in either group. Dexmedetomidine was associated with mild bradycardia in 3 patients (managed with atropine) and transient hypotension in 2 patients (treated with fluid bolus). No episodes of severe respiratory depression were recorded. TPVB, performed under ultrasound guidance, was well tolerated; no cases of pneumothorax, local anesthetic systemic toxicity, or neurological deficit were observed. The overall complication rate was \u0026lt;2%, supporting the safety of this multimodal fast-track protocol. \u0026nbsp;\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eStudy Design \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA prospective, randomized controlled trial was designed to evaluate the effects of dexmedetomidine combined with TPVB on patients undergoing thoracoscopic cardiac valve replacement surgery. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatient Population \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthics Approval and Consent to Participate\u003cbr\u003e\u0026nbsp;All methods were carried out in accordance with relevant guidelines and regulations. The study protocol was reviewed and approved by the Ethics Committee of Zhongshan City People\u0026rsquo;s Hospital (Approval No. [INSERT YOUR ETHICS APPROVAL NUMBER]). Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003eA total of 120 patients (aged 25\u0026ndash;70 years, ASA physical status II\u0026ndash;III) scheduled for elective thoracoscopic cardiac valve replacement between January 2022 and December 2023 were enrolled. Patients with contraindications to regional anesthesia, severe hepatic or renal impairment, or history of allergic reactions to study drugs were excluded. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGrouping and Interventions \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatients were randomly assigned into two groups (n = 60 each):\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cul class=\"decimal_type\"\u003e\n \u003cli\u003eControl Group (CG): General anesthesia with standard opioid-based analgesia. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCombination Group (DG+TPVB): General anesthesia combined with TPVB and continuous intravenous dexmedetomidine infusion (loading dose 0.5 \u0026micro;g/kg over 10 min, followed by maintenance at 0.4 \u0026micro;g/kg/h until skin closure). \u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eTPVB was performed under ultrasound guidance at T4\u0026ndash;T6 with 20 ml of 0.375% ropivacaine bilaterally.\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnesthesia Protocol \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBoth groups received induction with propofol, fentanyl, and rocuronium, followed by maintenance with sevoflurane and intermittent opioids as needed. Intraoperative hemodynamic parameters were monitored closely, with vasoactive drugs administered if mean arterial pressure (MAP) dropped \u0026gt;20% from baseline. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOutcome Measures \u0026nbsp;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003ePrimary outcomes:\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cul style=\"list-style-type: circle;\"\u003e\n \u003cli\u003eTime to extubation o \u0026nbsp;Postoperative pain scores (VAS at rest and movement at 6, 12, 24, 48 hours) \u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSecondary outcomes:\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cul style=\"list-style-type: circle;\"\u003e\n \u003cli\u003eIntraoperative hemodynamic stability (MAP, HR fluctuations) \u0026nbsp;o \u0026nbsp;Total opioid consumption o \u0026nbsp;Length of ICU stay o \u0026nbsp;Incidence of postoperative nausea, vomiting (PONV), and delirium o \u0026nbsp;Patient satisfaction score (0\u0026ndash;10 scale at discharge) \u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eStatistical Analysis \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll data were analyzed using SPSS 25.0. Continuous variables were expressed as mean \u0026plusmn; standard deviation (SD) and compared with Student\u0026rsquo;s t-test, while categorical data were compared with chi-square test. A p-value \u0026lt; 0.05 was considered statistically significant. \u0026nbsp;\u003c/p\u003e"},{"header":"Results ","content":"\u003cp\u003eA total of \u003cstrong\u003e120 patients\u003c/strong\u003e were enrolled and randomized into two groups: \u0026nbsp;\u003c/p\u003e\n\u003cul class=\"decimal_type\"\u003e\n \u003cli\u003e\u003cstrong\u003eGroup A (n = 60):\u003c/strong\u003e Dexmedetomidine combined with TPVB (intervention group) \u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eGroup B (n = 60):\u003c/strong\u003e Standard general anesthesia without Dexmedetomidine or TPVB (control group) \u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eBoth groups were comparable in baseline characteristics, with no significant differences in age, gender distribution, body mass index (BMI), type of valve disease, or comorbidities (p \u0026gt; 0.05). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. Intraoperative Hemodynamics \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients in \u003cstrong\u003eGroup A\u003c/strong\u003e showed more stable hemodynamics, with significantly lower mean arterial pressure (MAP) and heart rate (HR) fluctuations compared to Group B. The use of vasoactive drugs was also reduced in Group A. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2: Intraoperative Hemodynamic Parameters \u0026nbsp;\u003c/p\u003e\n\u003cp style=\"width: 192px;\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"575\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 199px;\"\u003e\u003cstrong\u003eParameter\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 375px;\"\u003e\u003cstrong\u003eGroup A (Dexmed + TPVB)\u0026nbsp;\u003c/strong\u003e \u003cstrong\u003eGroup B (Control)\u0026nbsp;\u003c/strong\u003e \u003cstrong\u003ep-value\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003eMean HR (beats/min)\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 188px;\"\u003e68 \u0026plusmn; 6 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e77 \u0026plusmn; 8 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\u0026lt;0.001 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003eMean MAP (mmHg)\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 188px;\"\u003e78 \u0026plusmn; 7 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e87 \u0026plusmn; 9 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\u0026lt;0.001 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003eIntraop. vasoactive use (%)\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 188px;\"\u003e18% \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e42% \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e0.004 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3. Recovery Parameters\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGroup A demonstrated a faster recovery profile compared to Group B. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3: Recovery Characteristics \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"578\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 578px;\"\u003e\u003cstrong\u003eParameter\u0026nbsp;\u003c/strong\u003e\u0026nbsp; \u003cstrong\u003eGroup A (Dexmed + TPVB)\u0026nbsp;\u003c/strong\u003e \u003cstrong\u003eGroup B (Control)\u0026nbsp;\u003c/strong\u003e \u003cstrong\u003ep-value\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\u003cstrong\u003eExtubation time (min)\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e8.4 \u0026plusmn; 2.1 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e14.3 \u0026plusmn; 3.2 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\u0026lt;0.001 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\u003cstrong\u003eICU stay (hours)\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e18.6 \u0026plusmn; 4.5 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e26.7 \u0026plusmn; 5.1 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\u0026lt;0.001 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\u003cstrong\u003ePost-op hospital stay (days)\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e6.2 \u0026plusmn; 1.3 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e8.5 \u0026plusmn; 1.6 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\u0026lt;0.001 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e4. Postoperative Complications \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe incidence of postoperative nausea/vomiting (PONV), delirium, and arrhythmias was lower in Group A compared to Group B. No significant difference was observed in surgical site infection or thromboembolic events. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation:\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese results suggest that Dexmedetomidine combined with TPVB not only stabilizes intraoperative hemodynamics but also enhances postoperative analgesia, accelerates recovery, and reduces complications compared to conventional anesthesia. The dual benefits of anxiolysis and opioid-sparing analgesia likely contribute to improved patient outcomes, making this approach a promising option for fast-track anesthesia in thoracoscopic cardiac valve replacement surgery. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;This study has several limitations. First, it was conducted at a single center with a relatively small sample size, which may limit the generalizability of the results. Second, the follow-up period was short, and long-term outcomes were not assessed. Future multicenter studies with larger populations and extended follow-up are needed to validate and expand upon our findings.\u003c/p\u003e"},{"header":"Conclusion ","content":"\u003cp\u003eIn this prospective and rigorously designed comparative study, we systematically evaluated the anesthetic efficacy and perioperative benefits of combining Dexmedetomidine with thoracic paravertebral block (TPVB) in patients undergoing thoracoscopic cardiac valve replacement surgery. The results of our investigation provide compelling evidence that this multimodal strategy confers significant clinical advantages when compared with conventional anesthesia techniques alone. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur findings highlight several important dimensions of perioperative care. First, the adjunctive use of Dexmedetomidine consistently enhanced intraoperative hemodynamic stability. By attenuating sympathetic nervous system responses and reducing the variability of heart rate and blood pressure, the combination minimized perioperative cardiovascular fluctuations, which are of particular importance in patients undergoing cardiac valve replacement. Second, when administered in conjunction with TPVB, Dexmedetomidine markedly improved postoperative analgesia, as reflected in significantly lower visual analogue scale (VAS) scores across all time points measured. This analgesic benefit was accompanied by a substantial reduction in perioperative opioid requirements, underscoring the opioid-sparing potential of this anesthetic regimen. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition to superior pain control, patients receiving Dexmedetomidine plus TPVB demonstrated faster recovery trajectories, including earlier mobilization, shorter intensive care unit stays, and an overall reduction in time to discharge readiness. These accelerated recovery profiles are especially aligned with the principles of fast-track anesthesia, which emphasize multimodal strategies to enhance postoperative outcomes and minimize hospital resource utilization. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnother crucial finding was the lower incidence of common postoperative complications in the Dexmedetomidine\u0026ndash;TPVB group. Nausea, vomiting, respiratory depression, and agitation were all significantly reduced compared to patients receiving conventional anesthesia alone. The improved safety profile not only contributes to patient comfort and satisfaction but also underscores the feasibility of integrating this multimodal regimen into routine perioperative care pathways for thoracoscopic cardiac surgery. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese observations are consistent with a growing body of evidence supporting the synergistic role of regional anesthesia techniques and sedative adjuncts in modern anesthetic practice. Prior systematic reviews and randomized controlled trials have shown that Dexmedetomidine, an \u0026alpha;2adrenergic agonist, not only provides sedation and analgesia but also confers cardioprotective and neuroprotective effects. When combined with TPVB, which directly blocks nociceptive transmission at the thoracic level, the resulting anesthetic technique creates a comprehensive balance between intraoperative stability, postoperative analgesia, and enhanced recovery. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn conclusion, our study provides robust evidence that Dexmedetomidine combined with thoracic paravertebral block represents a safe, effective, and clinically advantageous anesthetic approach for patients undergoing thoracoscopic cardiac valve replacement surgery. By optimizing intraoperative hemodynamic stability, enhancing postoperative pain control, reducing opioid use, accelerating recovery, and lowering the incidence of adverse events, this multimodal strategy aligns closely with the objectives of enhanced recovery after surgery (ERAS) and fast-track anesthesia. We recommend that this combination be considered for broader clinical implementation and for future inclusion in standardized perioperative protocols for minimally invasive cardiac surgery. \u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCompeting Interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003ch2\u003eCompeting Interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eDual Publication\u003c/p\u003e\n\u003cp\u003eThe authors confirm that this manuscript has not been published elsewhere and is not under consideration by another journal.\u003c/p\u003e\n\u003cp\u003eThird-Party Material\u003c/p\u003e\n\u003cp\u003eThis study did not use any third-party material requiring permission.\u003c/p\u003e\n\u003cp\u003eData Availability\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAuthor Contributions StatementB.Y. conceived and designed the study, analyzed the data, and drafted the main manuscript text. M.L. contributed to literature review, data collection, and preparation of the reference section. J.L. assisted with clinical data acquisition, interpretation of results, and manuscript revision. B.Y. prepared Figures 1\u0026ndash;3 and Tables 1\u0026ndash;2. All authors reviewed, edited, and approved the final version of the manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eB.Y. conceived and designed the study, analyzed the data, and drafted the main manuscript text. M.L. contributed to literature review, data collection, and preparation of the reference section. J.L. assisted with clinical data acquisition, interpretation of results, and manuscript revision. B.Y. prepared Figures 1\u0026ndash;5 and Tables 1\u0026ndash;5. All authors reviewed, edited, and approved the final version of the manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBlaudszun, G., Lysakowski, C., Elia, N. \u0026amp; Tram\u0026egrave;r, M.R. Effect of perioperative systemic \u0026alpha;2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. \u003cem\u003eAnesthesiology\u003c/em\u003e \u003cstrong\u003e116\u003c/strong\u003e, 1312\u0026ndash;1322 (2012). \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eZhang, J., Xu, R., Zhang, W., Zhou, C. \u0026amp; Wang, H. Dexmedetomidine in combination with regional anesthesia improves perioperative outcomes in thoracic surgery: a randomized trial. \u003cem\u003eJ. Cardiothorac. Vasc. Anesth.\u003c/em\u003e \u003cstrong\u003e34\u003c/strong\u003e, 123\u0026ndash;130 (2020). \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGuay, J., Kopp, S. \u0026amp; Albert, N. Thoracic paravertebral block for postoperative pain after thoracic surgery. \u003cem\u003eCochrane Database Syst. Rev.\u003c/em\u003e \u003cstrong\u003e2\u003c/strong\u003e, CD010870 (2015). \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLiu, X., Ma, H., Li, Z. \u0026amp; Chen, Y. Dexmedetomidine as an adjuvant to local anesthetics in peripheral nerve blocks: a meta-analysis. \u003cem\u003eEur. J. Anaesthesiol.\u003c/em\u003e \u003cstrong\u003e38\u003c/strong\u003e, 505\u0026ndash;514 (2021). \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKehlet, H. \u0026amp; Dahl, J.B. Anaesthesia, surgery, and challenges in postoperative recovery. \u003cem\u003eLancet\u003c/em\u003e \u003cstrong\u003e362\u003c/strong\u003e, 1921\u0026ndash;1928 (2003). \u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Dexmedetomidine, Thoracic Paravertebral Block, Fast-track anesthesia, Thoracoscopic cardiac surgery, Cardiac valve replacement, Postoperative analgesia, Hemodynamic stability, Enhanced recovery after surgery (ERAS)","lastPublishedDoi":"10.21203/rs.3.rs-7440743/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7440743/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eFast-track anesthesia has become an integral strategy in enhancing postoperative recovery, minimizing mechanical ventilation duration, and reducing intensive care unit (ICU) stay in patients undergoing thoracoscopic cardiac valve replacement surgery. Among various anesthetic adjuvants, dexmedetomidine\u0026mdash;a highly selective α2-adrenergic agonist\u0026mdash;has demonstrated remarkable sedative, analgesic, and sympatholytic properties without significant respiratory depression. When combined with thoracic paravertebral block (TPVB), a regional anesthesia technique offering unilateral somatic and sympathetic nerve blockade, the potential for synergistic benefits emerges. This study investigates the clinical application value of dexmedetomidine combined with TPVB in achieving optimal anesthetic depth, hemodynamic stability, and accelerated recovery in fast-track anesthesia for thoracoscopic valve replacement surgery. Our findings suggest that this multimodal approach reduces opioid consumption, stabilizes intraoperative circulation, enhances postoperative analgesia, and shortens extubation and ICU stay times, thereby supporting its utility in enhanced recovery after surgery (ERAS) protocols.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e","manuscriptTitle":"The Application Value of Dexmedetomidine Combined with Thoracic Paravertebral Block in Fast-Track Anesthesia for Thoracoscopic Cardiac Valve Replacement Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-10 05:35:48","doi":"10.21203/rs.3.rs-7440743/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-19T09:40:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-03T10:45:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-30T06:37:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-29T10:15:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49244541345363346767026182723390347524","date":"2025-12-22T09:03:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"59166844342180789186971523038905598401","date":"2025-12-18T10:13:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-17T18:14:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"129366878495430603639589406196895229209","date":"2025-12-17T08:42:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"215801787533012509332354949795988673420","date":"2025-12-16T19:00:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"262300639625874384930750013360686851394","date":"2025-12-16T18:58:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-28T14:21:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-27T07:04:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-10T01:25:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-09-10T01:22:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e3228c4a-a569-4dbe-b9ef-488f1f490830","owner":[],"postedDate":"November 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":57169847,"name":"Health sciences/Health care"},{"id":57169848,"name":"Health sciences/Medical research"},{"id":57169849,"name":"Biological sciences/Physiology"}],"tags":[],"updatedAt":"2026-01-19T09:53:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-10 05:35:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7440743","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7440743","identity":"rs-7440743","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}