Local Anesthetic, Magnesium Sulfate, Modified Radical Mastectomy, Pectoral Nerve, Postoperative Pain, Stellate Ganglion Block
Conditions
Brief summary
We aim to study the effect of adding magnesium sulfate as an adjuvant to the local anesthetic used in the combined Pectoralis Nerve Block II (PECS II) and stellate ganglion block for postoperative pain control in patients undergoing modified radical mastectomy.
Detailed description
Post-operative pain from breast surgery can be controlled by regular pain medications such as paracetamol, non-steroidal anti-inflammatory (NSAIDs), and narcotics. Nerve blocks are commonly used as multimodal approaches for acute post-operative pain relief. Pectoral and stellate ganglion blocks are regional anesthesia techniques that target the thoracic nerves and sympathetic nerve ganglia to provide analgesia for the upper extremity and chest regions. When combined, these blocks have shown promising results in alleviating perioperative pain for patients undergoing modified radical mastectomy. Magnesium sulfate, a well-known adjuvant, has been studied extensively for its analgesic properties and anti-inflammatory effects.
Interventions
DRUGBupivacaine
Patients received the combined pectoralis nerve block II (PECS II) (20 mL) and stellate ganglion block (5 mL) using 0.5% bupivacaine (local anesthetic) without magnesium sulfate.
Patients received the combined (20 mL) pectoralis nerve block II (PECS II) and stellate ganglion block (5 mL) using 0.5% bupivacaine (local anesthetic) mixed with 2.5 mL magnesium sulfate (10%), i.e., 250 mg.
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥18 years. * Female gender. * American Society of Anesthesiologists (ASA) physical status II or III. * Patients scheduled for elective modified radical mastectomy for breast cancer. * Body mass index (BMI): \> 20 kg/m2 and \< 40 kg/m2.
Exclusion criteria
* Bleeding tendency due to coagulopathy, * Patients with opioid dependence or alcohol or drug abuse, * Significant liver and renal sufficiency * Patients with psychiatric illnesses that prevent them from proper perception and assessment of pain. * Local infection at the site of the block. * Known hypersensitivity or allergy to magnesium sulfate or local anesthetics. * Patients with chronic pain syndromes or pre-existing neuropathic pain conditions. * Pregnant or lactating individuals.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total morphine consumption | 24 hours postoperatively | With numeric rating scale (NRS) rest score ≥ 3 or NRS evoked score ≥ 4, morphine will be administered intravenously by a dose of 0.05 mg/kg at 30-minute intervals until NRS rest score \< 3 or NRS evoked score \< 4. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Degree of pain | 24 hours postoperatively | The severity of pain will be assessed postoperatively using a numeric rating scale (NRS) both at rest and evoked (0 = no pain and 10 = worst imaginable pain). NRS will be recorded at 1, 2, 4, 6, 8, 10, 12, and 24 hours postoperatively. |
| Time to first request analgesia | 24 hours postoperatively | The time to first request analgesia will be recorded from the end of surgery till the first dose of morphine is administrated. |
| Incidence of adverse events | 24 hours postoperatively | Incidence of adverse events such as nausea and vomiting will be recorded. |
Countries
Egypt
Outcome results
None listed