Background: Loco-regional anaesthesia (GA) has been extensively applied in the clinical field for achieving post-operative analgesia. Erector spinae plane block (ESPB) which is a novel inter-fascial plane block has been widely used for breast surgery. Dexmedetomidine and dexamethasone as an adjunct to local anaesthesia have been widely reported to reduce postoperative pain and analgesic consumption but there are no studies comparing both these drugs in ESPB for breast surgery.Methods: Sixty ASA I-II patients scheduled for breast surgery were randomly allocated into two groups-Group DX and group DM. Group DX received 20 ml ropivacaine 0.2% with dexmedetomidine 0.5 mcg/kg while group DM received 20 ml ropivacaine 0.2 % with 8 mg dexamethasone in ESPB preemptively. All the patients were induced with standard GA and extubated at the end of surgery. In the post-operative period visual analogue scale (VAS) pain score, total tramadol consumption, time for first rescue analgesia and side effects were noted for 24 hours.Results: The demographical parameters were comparable between both the groups. The VAS score, total tramadol consumption and time for first rescue analgesia were both similar in both the groups without any significant difference. No side effects were noted in any patients in both the groups.Conclusions: Dexmedetomidine (0.5 mcg/kg) and dexamethasone (8 mg) as an adjunct to ropivacaine reduces postoperative pain and analgesic consumption with no significant difference when used in ESPB for patients undergoing breast surgery without any side effects.

Background: Modified radical mastectomy (MRM) is the most common surgery for cancer breast that is associated with marked postoperative pain. Effective control of this pain suppresses the surgical stress response and decreases the need for opioids and general anesthetics. This study was aimed to compare ultrasound guided erector spinae block (US-ESP) with modified pectoralis nerve block (US-PECS) in terms of post-operative pain scores as the primary objective, in patients undergoing MRM. The secondary objectives of our study were to compare the time of first rescue analgesic, total analgesic consumption and side-effects between the two groups.Methods: Group E comprised of patients receiving 20 mL of 0.2% ropivacaine plus 0.5 µ/kg dexmedetomidine and it was injected in‑between erector spinae muscle and transverse process. Group P comprised of patients receiving 30 mL of 0.2% ropivacaine plus 0.5 µg/kg dexmedetomidine divided into 10 mL that was injected between the two pectoralis muscles in the inter-fascial plane and the remaining 20 mL was injected between the serratus anterior and the pectoralis minor muscle.Results: Demographic profile was comparable between both groups. Both groups offered good analgesia, but PECS group took an upper hand up to the 6th post-operative hour (p<0.05). Beyond the 6th post-operative hour, analgesic efficacy of both groups was comparableConclusions: Modified pectoralis nerve block offered better analgesia over the erector spinae block technique up to 6th post-operative hour and it is more effective in terms of total rescue analgesic consumption and the time for request of first rescue analgesic, in patients posted for MRM.

Introduction: Thoracic epidural anaesthesia (TEA) has been the standard of care for postoperative pain management for patients undergoing  abdomino-thoracic esophagectomy. The study aims to observe whether addition of lumbar intrathecal morphine along with TEA reduces the post operative pain scores, post operative opioid consumption and total epidural drug requirement.  Materials and methods:50 patients divided into two groups, one group was given standard TEA at level T5-T7, other group was receiving intrathecal morphine along with TEA. General anaesthesia will be provided as per standard protocol and one lung isolation will be achieved using Robertsons  double lumen tube of proper size. Pain scores will be monitored using Numerical rating Scale. Total requirement of epidural drug in both the groups , requirement of rescue analgesia, complications in both the groups will be observed. Results and observations: In our study we found that VAS score were better in the combined intrathecal morphine plus thoracic intrathecal morphine plus thoracic epidural approach group and there were less need of rescue analgesia and good recovery compared to conventional thoracic epidural approach. Haemodynamic parameters and complications were almost comparable in both the groups except for heart rate.

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