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Efficacy of dexmedetomidine as an adjuvant in paravertebral block in breast cancer surgery

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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, 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 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.

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Acknowledgments

We wish to thank Dr. Rajeev Kumar, Department of Biostatistics and Medical Informatics, University College of Medical Sciences, for his assistance in conducting statistical analysis for this study.

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Authors and Affiliations

  1. Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India

    Medha Mohta, Bhumika Kalra & Ashok K. Sethi

  2. Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India

    Navneet Kaur

  3. 28-B, Pocket-C, SFS Flats, Mayur Vihar Phase-III, Delhi, 110096, India

    Medha Mohta

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  1. Medha Mohta
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Correspondence to Medha Mohta.

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Mohta, M., Kalra, B., Sethi, A.K. et al. Efficacy of dexmedetomidine as an adjuvant in paravertebral block in breast cancer surgery. J Anesth 30, 252–260 (2016). https://doi.org/10.1007/s00540-015-2123-8

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  • DOI: https://doi.org/10.1007/s00540-015-2123-8

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