Medha Mohta1,2, Bhumika Kalra3, Ashok K Sethi3, Navneet Kaur4. 1. Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India. medhamohta@hotmail.com. 2. , 28-B, Pocket-C, SFS Flats, Mayur Vihar Phase-III, Delhi, 110096, India. medhamohta@hotmail.com. 3. Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India. 4. Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.
Abstract
PURPOSE: This study evaluated the analgesic efficacy of dexmedetomidine in combination with bupivacaine for single-shot paravertebral block (PVB) in patients undergoing major breast cancer surgery. METHODS: This prospective, randomized double blind study was conducted in 45 ASA I/II/III females, aged ≥18 years, undergoingmodified radical mastectomy or breast conservation surgery with axillary lymph node dissection. Patients in group PB (paravertebral-bupivacaine) received PVB with 0.5 % bupivacaine 0.3 ml/kg with 1 ml normal saline; group PBD (paravertebral-bupivacaine-dexmedetomidine) received PVB with 0.5 % bupivacaine 0.3 ml/kg and dexmedetomidine 1 μg/kg in a volume of 1 ml; and group C (control) patients were given a sham block (a subcutaneous injection with 2 ml normal saline) before receiving general anesthesia (GA). All patients received analgesia by fentanyl intraoperatively and morphine patient-controlled analgesia postoperatively. RESULTS: The control group patients required more intraoperative fentanyl than the other two groups. Patients receiving dexmedetomidine had lower morphine consumption (p < 0.001), pain scores and incidence of postoperative nausea/vomiting (p = 0.011); longer time to first analgesic request; earlier time to mobilize; and better satisfaction scores. Heart rate and blood pressure values during the intraoperative period were also lower at many time points in this group. However, the incidence of hypotension and bradycardia were statistically similar in all groups. CONCLUSIONS: PVB using dexmedetomidine 1 µg/kg added to 0.5 % bupivacaine in patients undergoing major breast cancer surgery under GA provides analgesia of longer duration with decreased postoperative opioid consumption and lower incidence of nausea/vomiting compared to PVB with bupivacaine alone or no PVB.
RCT Entities:
PURPOSE: This study evaluated the analgesic efficacy of dexmedetomidine in combination with bupivacaine for single-shot paravertebral block (PVB) in patients undergoing major breast cancer surgery. METHODS: This prospective, randomized double blind study was conducted in 45 ASA I/II/III females, aged ≥18 years, undergoing modified radical mastectomy or breast conservation surgery with axillary lymph node dissection. Patients in group PB (paravertebral-bupivacaine) received PVB with 0.5 % bupivacaine 0.3 ml/kg with 1 ml normal saline; group PBD (paravertebral-bupivacaine-dexmedetomidine) received PVB with 0.5 % bupivacaine 0.3 ml/kg and dexmedetomidine 1 μg/kg in a volume of 1 ml; and group C (control) patients were given a sham block (a subcutaneous injection with 2 ml normal saline) before receiving general anesthesia (GA). All patients received analgesia by fentanyl intraoperatively and morphinepatient-controlled analgesia postoperatively. RESULTS: The control group patients required more intraoperative fentanyl than the other two groups. Patients receiving dexmedetomidine had lower morphine consumption (p < 0.001), pain scores and incidence of postoperative nausea/vomiting (p = 0.011); longer time to first analgesic request; earlier time to mobilize; and better satisfaction scores. Heart rate and blood pressure values during the intraoperative period were also lower at many time points in this group. However, the incidence of hypotension and bradycardia were statistically similar in all groups. CONCLUSIONS:PVB using dexmedetomidine 1 µg/kg added to 0.5 % bupivacaine in patients undergoing major breast cancer surgery under GA provides analgesia of longer duration with decreased postoperative opioid consumption and lower incidence of nausea/vomiting compared to PVB with bupivacaine alone or no PVB.
Entities:
Keywords:
Breast surgery; Bupivacaine; Dexmedetomidine; Paravertebral block; Postoperative pain
Authors: Mahmoud M Al-Mustafa; Sami A Abu-Halaweh; Abdelkarim S Aloweidi; Mujalli M Murshidi; Bassam A Ammari; Ziad M Awwad; Ghazi M Al-Edwan; Micheal A Ramsay Journal: Saudi Med J Date: 2009-03 Impact factor: 1.484
Authors: Hongxing Zhang; Fang Zhou; Chen Li; Min Kong; He Liu; Peng Zhang; Song Zhang; Junli Cao; Licai Zhang; Hong Ma Journal: PLoS One Date: 2013-02-07 Impact factor: 3.240
Authors: Wei Fan; Hong Xue; Yong Sun; HaiKou Yang; Jun Zhang; Guangming Li; Ying Zheng; Yi Liu Journal: Front Pharmacol Date: 2017-05-09 Impact factor: 5.810