A comparative study to assess the quality of analgesia of bupivacaine and bupivacaine with dexmedetomidine in ultrasound-guided pectoral nerve block type I and II in breast surgeries

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SCIENCE
A comparative study to assess the quality of analgesia of bupivacaine and bupivacaine with dexmedetomidine in ultrasound-guided pectoral nerve block type I and II in breast surgeries
Key Take-Away: 

Various modalities provide postoperative analgesia in breast cancer surgeries for example opiates, nonsteroidal anti-inflammatory agents, wound infiltration with local anaesthetic agents, thoracic epidural, and paravertebral blocks. This randomized study explored the efficacy of dexmedetomidine regarding prolonged duration and improved quality of postoperative analgesia further supporting bupivacaine in pecs I and II blocks.

Dexmedetomidine has been proved to be safe and efficacious in sustaining the duration of peripheral nerve blocks.

ABSTRACT: 
Background: 

Dexmedetomidine has been proved to be safe and efficacious in sustaining the duration of peripheral nerve blocks.

This study compared the duration, quality of postoperative analgesia, hemodynamic stability, and patient's satisfaction with the addition of dexmedetomidine to bupivacaine versus plain bupivacaine in pectoral nerve block (Pecs) type I and II in breast surgeries.

Methods: 

The prospective randomized double-blind study was executed in 60 American Society of Anesthesiologists grade I–III female patients, within the age group of 18 to 70 years, randomly allocated into two equal groups.

In Group A, 10 ml 0.25% bupivacaine for pecs I block was given to the patients and in Group B, 20 ml 0.25% bupivacaine for pecs II block.
Group B received 10 ml 0.25% bupivacaine with dexmedetomidine for pecs I block and 20 ml 0.25% bupivacaine with dexmedetomidine in pecs II block, keeping a total dose of dexmedetomidine of 1 μg/kg body weight and same volume in both the groups.

Results: 

In Group B, Numerical rating scores at rest and on the abduction of the arm were significantly lower. The complete analgesia in the dexmedetomidine group (1024.0 ± 124.9 min) increased to 40% as compared to plain bupivacaine (726.4 ± 155.3 min; P < 0.001).

Total consumption of injection diclofenac sodium in 24 h was 23% less in Group B (77.5 ± 13.6 mg) as opposed to Group A (100.0 ± 35.9 mg, P = 0.003). Better patient satisfaction score was observed in the dexmedetomidine group. No adverse effects were noted in either group.
 

Conclusion: 

Dexmedetomidine as an adjunct to bupivacaine helps prolong the duration and improves the quality of postoperative analgesia in pecs I and II block without serious side effects.

Source

Journal of Anaesthesiology Clinical Pharmacology 

Link:

http://www.joacp.org/article.asp?issn=0970-9185;year=2018;volume=34;issue=2;spage=227;epage=231;aulast=Manzoor

Original title of article:

A comparative study to assess the quality of analgesia of bupivacaine and bupivacaine with dexmedetomidine in ultrasound-guided pectoral nerve block type I and II in breast surgeries

Authors:

Shaiqa Manzoor et al.

Therapeutic, Bupivacaine, Dexmedetomidine, Pain, Breast, Anesthetic, Opioids, Nonsteroidal anti-inflammatory agents,Prospective randomized double-blind study, Numerical rating scores
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