Background: General anaesthesia is used for breast cancer surgery. The downside of generalanaesthesia includes inadequate pain control and a high incidence of nausea and vomiting. Generalanaesthesia with intravenous dexmedetomidine or intercostal nerve block reduce the incidence ofpostoperative pain. Objective: To evaluate the effectiveness of intravenous dexmedetomidine compared to intercostal nerveblocks in patients undergoing simple mastectomy with axillary dissection under general anaesthesia.Methods:It was a single-blinded prospective randomized comparative study. This study was conductedat the Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh MujibMedical University (BSMMU), Dhaka from March 2018 to March 2019. A total of 60 patients sufferingfrom breast cancer admitted in the Department of General Surgery of BSMMU Dhaka and scheduledfor simple mastectomy with axillary dissection, were enrolled in this study. Results: Age ,height andweight were almost identical between two groups. Duration of anaesthesia and surgery were almostsimilar between two groups. The mean heart rate, systolic blood pressure, diastolic blood pressure ,mean arterial pressure did not significantly fluctuate in subsequent baseline follow up and 15 minuteand at 160 minutes parameters were almost similar within two groups.Mean time to achieve adequateAldrete recovery score after extubation was almost similar between two groups. Postoperative sedationlevel was also similar between two groups. Majorty of the surgeon were satisfied about anaesthesiatechnique in both group A and group B. Mean time of rescue analgesic requirement in postoperativeperiod was satistically significant (p<0.05) between two group but it was clinically less significant(groupA= 112 minutes and groupB=141minutes. Conclusion: Intravenous dexmedetomidine may be an alternative to intercostal nerve blocks inpatients undergoing simple mastectomy with axillary dissection under general anaesthesia as itprovided stable intraoperative haemodynamics, reduced blood loss and analgesic requirement, smoothrecovery, postoperative sedation level and surgeon satisfaction as well as intercostal nerve blocks. JBSA 2021; 34 (2) : 24-35

Background: Postoperative pain following unilateral modified radical mastectomy (MRM) has been managed with Pectoral nerve block (PEC block). Several initiatives are ongoing to get the effective and safe way of prolongation analgesic effect postoperatively. Therefore, many types of adjuvants are adding to the local anaesthetic agents to prolong their analgesic effect. In this study either dexamethasone or magnesium sulphate (MgSO4) has added as an adjuvant to 0.25% bupivacaine in pectoral plane block (PEC block) for unilateral modified radical mastectomy. Here we observed which of the adjuvant would prolong the analgesic effect of 0.25% bupivacaine. Methods: This randomized controlled trial was conducted at the Department of Anaesthesia, Analgesia, Palliative and Intensive Care Medicine, Dhaka Medical College following approval of the ethical committee. These patients were selected from the department of General Surgery, Dhaka Medical College during preanaesthetic checkup periods. Total 50 patients were scheduled for modified radical mastectomy and divided into Group A and Group B (each group contain 25 patients). The patients of the both groups were given pectoral plane block under ultrasound guide with 0.25% bupivacaine. The patients of Group A received magnasium sulphate 150 mg and Group B received dexamethasone 10 mg as an adjuvant to 0.25% bupivacaine. Pectoral nerve block was performed before induction of general anaesthesia and onset of sensory block was assessed among the both groups. All patients were observed peri-operatively and data were recorded into the data collection form. Finally, data was analyzed by SPSS version 22. Observation and Results: Socio-demographic profile were similar among the both groups (p>0.05). No significant difference was noted in terms of ASA score and BMI (p>0.05). Mean duration of the analgesia (min) and time requirement of rescue analgesic therapy were significantly higher in dexamethasone group (p<0.05) than MgSO4 group. Post-operative requirement of pethidine (72.5±8.5vs 55.2±5.4 mg; p<.045) was also higher in MgSO4 group. Side effects profile like nausea and vomiting also significantly small in dexamethasone (4%) group than people received MgSO4 group (20%) (p<0.05). Conclusion: Use of dexamethasone in comparison to MgSO4 as an adjuvant to bupivacaine could prolong analgesia in postoperative period for pectoral plane block in unilateral modified radical mastectomy. CBMJ 2022 January: vol. 11 no. 01 P: 4-13