Efficacy of Dexmedetomidine vs Morphine as an Adjunct in a Paravertebral Block with Bupivacaine in Postoperative Analgesia Following Modified Radical Mastectomy

Malik Jamil Ahmed, Abaid Ur Rehman, Rana Muhammad Arshad, Muhammad Wasim Ali Amjad, Zeeshan Khan, Aamir Furqan, Malik Jamil Ahmed, Abaid Ur Rehman, Rana Muhammad Arshad, Muhammad Wasim Ali Amjad, Zeeshan Khan, Aamir Furqan

Abstract

Objective To observe the efficacy of dexmedetomidine vs morphine as an adjunct in a paravertebral block (PVB) with bupivacaine in postoperative analgesia following modified radical mastectomy. Study design This was a randomized controlled trial performed from June 2018 to August 2019 in the Department of Anesthesia, Bakhtawar Amin Medical and Dental College, Ch. Pervaiz Ellahi Institute of Cardiology, Multan, Gurki Hospital, Services Institute of Medical Sciences, and Sheikh Zayed Hospital, Lahore. Methodology Seventy-eight patients were equally divided into group M, which received morphine (3 mg) and group D, which received dexmedetomidine (1 µg/kg), along with 20 cc 0.25% bupivacaine, for PVB. The primary outcome included morphine requirements in the post-anesthesia care unit (PACU). Secondary outcomes included the quality and duration of analgesia, intraoperative doses of fentanyl and propofol, postoperative doses of diclofenac required, postoperative nausea and vomiting (PONV), and the Ramsey sedation score. Data were entered into SPSS version 23 (IBM Corp., Armonk, NY) and analyzed by applying the independent t-test, Mann Whitney U-test, and the chi-square test or Fischer's exact test, as appropriate. P≤0.05 was considered statistically significant. Results The mean time for the first analgesic administration was much shorter in group D as compared to group M (p<0.001). The average doses of ephedrine and morphine used were higher in group D (p-value 0.033 and 0.013, respectively). In the PACU, 33.3% of group D patients as compared to 12.8% of group M patients needed morphine (p=0.032). Postoperatively, diclofenac consumption was higher in group D (p<0.001). Postoperative pain was lower and sedation was higher in group M (p<0.05). Conclusion As an adjunct to bupivacaine in PVB for MRM, morphine is superior to dexmedetomidine.

Keywords: dexmedetomidine; modified radical mastectomy (mrm); morphine; paravertebral block (pvb).

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2020, Ahmed et al.

References

    1. Tarver T. J Consum Health Internet. Vol. 16. Atlanta, GA: American Cancer Society; 2012. Cancer facts & figures 2012. American Cancer Society (ACS) pp. 366–367.
    1. American Cancer Society. Cancer facts & figures for Hispanics. American Cancer Society. 2009
    1. Chronic postoperative pain after general anesthesia with or without a single-dose preincisional paravertebral nerve block in radical breast cancer surgery [Article in Spanish] Ibarra MM, S-Carralero GC, Vicente GU, del Pozo Cuartero A, López RR, del Castillo Fajardo MJ. Rev Esp Anestesiol Reanim. 2011;58:290–294.
    1. Risk factors for chronic pain following breast cancer surgery: a prospective study. Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, Dworkin RH. J Pain. 2006;7:626–634.
    1. Perioperative breast analgesia: a qualitative review of anatomy and regional techniques. Woodworth GE, Ivie RM, Nelson SM, Walker CM, Maniker RB. Reg Anesth Pain Med. 2017;42:609–631.
    1. Evaluation of the role of dexmedetomidine in improvement of the analgesic profile of thoracic paravertebral block in thoracic surgeries: a randomised prospective clinical trial. Hassan ME, Mahran E. Indian J Anaesth. 2017;61:826–831.
    1. Effects of adding dexamethasone or ketamine to bupivacaine for ultrasound-guided thoracic paravertebral block in patients undergoing modified radical mastectomy: a prospective randomized controlled study. El Mourad MB, Amer AF. Indian J Anaesth. 2018;62:285–291.
    1. Efficacy of dexmedetomidine as an adjuvant in paravertebral block in breast cancer surgery. Mohta M, Kalra B, Sethi AK, Kaur N. J Anesth. 2016;30:252–260.
    1. Dexmedetomidine as an adjunctive analgesic with bupivacaine in paravertebral analgesia for breast cancer surgery. Mohamed SA, Fares KM, Mohamed AA, Alieldin NH. Pain Phys. 2014;17:589–598.
    1. Comparison between dexmedetomidine versus morphine added to bupivacaine in paravertebral block in patients scheduled for modified radical mastectomy. Morsy AR, Abd-elmaksoud MM, Aziz RA, Metwally M. Res Opinion Anesth Intens Care. 2017;4:59–64.
    1. Paravertebral blocks in breast cancer surgery: is there a difference in postoperative pain, nausea, and vomiting? Aufforth R, Jain J, Morreale J, Baumgarten R, Falk J, Wesen C. Annals Surg Oncol. 2012;19:548–552.
    1. Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: a randomized clinical trial. Bashandy GM, Abbas DN. Reg Anesth Pain Med. 2015;40:68–74.
    1. Paravertebral block. Tighe S, Greene MD, Rajadurai N. Contin Educ Anaesth Crit Care Pain. 2010;61:178–179.
    1. Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy. Kairaluoma PM, Bachmann MS, Korpinen AK, Rosenberg PH, Pere PJ. Anesth Analg. 2004;99:1837–1843.
    1. Intrathecal bupivacaine in comparison with a combination of nalbuphine and bupivacaine for subarachnoid block: a randomized prospective double-blind clinical study. Tiwari AK, Tomar GS, Agrawal J. Am J Ther. 2013;20:592–595.
    1. Paravertebral block with morphine or dexmedetomidine as adjuvant to bupivacaine for post-operative analgesia in modified radical mastectomy: a prospective, randomised, double-blind study. Megha T, Hegde HV, Rao PR. Indian J Anaesth. 2018;62:424–430.
    1. Thoracic paravertebral block for breast surgery. Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass RA. Anesth Analg. 2000;90:1402–1405.
    1. Post-operative pain and analgesic requirements after paravertebral block for mastectomy: a randomized controlled trial of different concentrations of bupivacaine and fentanyl. Bhuvaneswari V, Wig J, Mathew PJ, Singh G. Indian J Anaesth. 2012;56:34–39.
    1. Nerve-stimulator guided paravertebral blockade vs. general anaesthesia for breast surgery: a prospective randomized trial. Naja MZ, Ziade MF, Lönnqvist PA. Eur J Anaesthesiol. 2003;20:897–903.
    1. Effect of continuous paravertebral dexmedetomidine administration on intraoperative anesthetic drug requirement and post-thoracotomy pain syndrome after thoracotomy: a randomized controlled trial. Dutta V, Kumar B, Jayant A, Mishra AK. J Cardioth Vasc An. 2017;31:159–165.

Source: PubMed

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