Bupivacaine, Dexmedetomidine, Erector Spinae Plane Block, Mastectomy, Pain Management, Serratus Anterior Plane Block, Ultrasound
Conditions
Brief summary
This study aimed to compare the serratus plane block versus the erector spinae plane block with dexmedetomidine added to bupivacaine for acute pain management after breast surgeries.
Detailed description
Approximately 40-60% of breast surgery patients endure severe acute postoperative pain, with over 10% of patients experiencing severe pain for six to twelve months (post-mastectomy pain syndrome). Dexmedetomidine has analgesic properties, which could be related to the stimulation of α2 adrenoceptors, inhibition of nerve conduction through C and Aδ fibers, and the local release of encephalin. Serratus plane block (SPB) is an effective approach for breast surgery analgesia due to its simplicity of delivery, minimal risk of adverse effects, and ability to provide significant pain relief. The erector spinae plane block (ESPB) is one of the emerging regional techniques for managing postoperative pain. ESPB can be given unilaterally during modified radical mastectomy.
Interventions
Patients received serratus anterior plane block on the operated side with bupivacaine 0.25% plus 0.5 µg/kg dexmedetomidine in 30 ml.
Sponsors
Kafrelsheikh University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Women aged \>20 years. * Patient's approval. * American Society of Anesthesiologists (ASA) physical status I-II. * Patients underwent breast surgeries.
Exclusion criteria
* Known allergy to local anesthetics, opioids, or dexmedetomidine medications. * Advanced heart block, ventricular dysfunction. * Skin infection at the site of injection. * Pre-existing chronic pain. * Coagulopathies, significant liver or renal insufficiency.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total dose of pethidine consumption | 24 hours postoperatively | Patients get 1 g paracetamol IV like clockwork. Salvage absence of pain as bolus IV pethidine at 0.5 mg/kg was managed if NRS \> 3 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intraoperative fentanyl consumption | Intraoperatively | In case the cruel blood vessel weight (Outline) or heart rate (HR) went over 20% of pattern values, additional bolus dosages of 0.5 µg/kg IV fentanyl were given. |
| Heart rate | Every 15 minutes until the end of the surgery (Up to 2 hours) | Heart rate was measured preoperatively and intraoperatively every 15 minutes until the end of the surgery. |
| Mean arterial pressure | Every 15 minutes until the end of the surgery (Up to 2 hours) | Mean arterial pressure was measured preoperatively and intraoperatively every 15 minutes until the end of the surgery. |
| Degree of pain | 24 hours postoperatively | Each patient was instructed about postoperative pain assessment with the numeric rating scale (NRS) score. NRS (0 represents no pain while 10 represents the worst pain imaginable). NRS was assessed at post anesthesia care unit, 1, 2, 6, 12, 18, and 24 hours postoperatively |
| Incidence of complications | 24 hours postoperatively | Incidence of complications such as hypotension, bradycardia, and postoperative nausea and vomiting (PONV) were recorded. |
Countries
Egypt
Outcome results
None listed