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

Manzoor, Shaiqa; Taneja, Rajeev; Sood, Neha; Puri, Archana; Kadayaprath, Geeta

doi:10.4103/joacp.joacp_366_16

Cited by 15 publications

(3 citation statements)

References 24 publications

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“…Since PECS, ESPB, INB, and PVB have similar effects, they have been frequently compared recently, and PECS has certain advantages in breast cancer. 97,113,114 Manzoor et al 115 reported that PECS with 1 μg/kg dexmedetomidine as an adjuvant of bupivacaine could prolong the duration of postoperative analgesia and improve the quality of postoperative analgesia without serious side effects. Kaur et al 116 focused on pain and stress, presenting that dexmedetomidine at 1 μg/kg in PECS provided better analgesia and greater inhibition of stress hormone levels (cortisol and prolactin) without serious side effects.…”

Section: Erector Spinae Plane Block (Espb)mentioning

confidence: 99%

Dexmedetomidine as an Adjuvant in Peripheral Nerve Block

Chen¹,

Liu²,

Feng³

et al. 2023

DDDT

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Peripheral nerve block technology is important to balanced anesthesia technology. It can effectively reduce opioid usage. It is the key to enhance clinical rehabilitation as an important part of the multimodal analgesia scheme. The emergence of ultrasound technology has accelerated peripheral nerve block technology development. It can directly observe the nerve shape, surrounding tissue, and diffusion path of drugs. It can also reduce the dosage of local anesthetics by improving positioning accuracy while enhancing the block’s efficacy. Dexmedetomidine is a highly selective drug α 2 -adrenergic receptor agonist. Dexmedetomidine has the characteristics of sedation, analgesia, anti-anxiety, inhibition of sympathetic activity, mild respiratory inhibition, and stable hemodynamics. Numerous studies have revealed that dexmedetomidine in peripheral nerve blocks can shorten the onset time of anesthesia and prolong the time of sensory and motor nerve blocks. Although dexmedetomidine was approved by the European Drug Administration for sedation and analgesia in 2017, it has not yet been approved by the US Food and Drug Administration (FDA). It is used as a non-label drug as an adjuvant. Therefore, the risk-benefit ratio must be evaluated when using these drugs as adjuvants. This review explains the pharmacology and mechanism of dexmedetomidine, the effect of dexmedetomidine on various peripheral nerve block as an adjuvant, and compare it with other types of adjuvants. We summarized and reviewed the application progress of dexmedetomidine as an adjuvant in nerve block and look forward to its future research direction.

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Section: Erector Spinae Plane Block (Espb)mentioning

confidence: 99%

Dexmedetomidine as an Adjuvant in Peripheral Nerve Block

Chen¹,

Liu²,

Feng³

et al. 2023

DDDT

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“…Twenty-two of them were excluded. Finally, 37 studies were included in the quantitative synthesis,9,10,17–19,24–55 and 47 studies were included in the qualitative synthesis9,10,17–19,24–65 (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Pectoral Nerve Block (Pecs) Compared With Control, Paravertebral Block, Erector Spinae Plane Block, and Local Anesthesia in Patients Undergoing Breast Cancer Surgeries

Elshanbary¹,

Zaazouee

Darwish

et al. 2021

The Clinical Journal of Pain

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Objective: We aimed to compare the safety and efficacy of pectoral nerve block (Pecs) I and II with control or other techniques used during breast cancer surgeries such as local anesthesia, paravertebral block, and erector spinae plane block (ESPB). Methods:We searched 4 search engines (PubMed, Cochrane Library, Scopus, and Web of Science) for relevant trials, then extracted the data and combined them under random-effect model using Review Manager Software. Results:We found 47 studies, 37 of them were included in our metaanalysis. Regarding intraoperative opioid consumption, compared with control, a significant reduction was detected in Pecs II (standardized mean difference [SMD] = −1.75, 95% confidence interval [CI] [−2.66, −0.85], P = 0.0001) and Pecs I combined with serratus plane block (SMD = −0.90, 95% CI [−1.37, −0.44], P = 0.0002). Postoperative opioid consumption was significantly lowered in Pecs II (SMD = −2.28, 95% CI [−3.10, −1.46], P < 0.00001) compared with control and Pecs II compared with ESPB (SMD = −1.75, 95% CI [−2.53, −0.98], P < 0.00001). Furthermore, addition of dexmedetomidine to Pecs II significantly reduced postoperative opioid consumption compared with Pecs II alone (SMD = −1.33, 95% CI [−2.28, −0.38], P = 0.006). Conclusion:Pecs block is a safe and effective analgesic procedure during breast cancer surgeries. It shows lower intra and postoperative opioid consumption than ESPB, and reduces pain compared with control, paravertebral block, and local anesthesia, with better effect when combined with dexmedetomidine.

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“…The extended duration observed in this research may be ascribed to the use of dexmedetomidine at a dosage of 1 µg/kg, which is higher than the dosage of 0.5 µg/kg employed in this particular investigation. [23].…”

Section: Side Effect Of Post-operative In Research Groups (Table Seven)mentioning

confidence: 99%

Analgesic Efficacy of Dexmedetomidine as Adjuvant to Levo-Bupivacine in Ultrasound Guided Erector Spinae Plan Block for Modified Radical Mastectomy

Mohamed,

Mohamed

et al. 2023

ijmst

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Background& aim: There are several advantages to properly managing post-masctetomy pain. With single shot interfascial plane blocks, local anesthetic adjuvants enhance analgesia duration. They improve the analgesic impact of local anesthetics. Dexamethasone, magnesium sulphate and dexmedetomidine, are examples of adjuvants with diverse modes of action. This research examined the analgesic effects of dexmedetomidine in women who had undergone a modified radical mastectomy (MRM). Methods and Patients: The research included forty women with histopathologically confirmed breast cancer. They were all scheduled for MRM and were randomly assigned to one of two groups: those who got levobupivacaine alone (group C) or those who received dexmedetomidine plus levobupivacaine (group D) during ultrasound (US)-guided erector spinae plane block (ESPB). The two groups were compared in terms of their hemodynamics, demographics, time until the first request for analgesia, numeric rating scale (NRS) scores, Richmond Agitation & Sedation scale (RASS) scores and total opioid use. Results: There were no statistically significant differences observed between the two groups in terms of baseline data. The set of participants referred to as group D had a statistically significant reduction in heart rate on many instances. Furthermore, it was discovered that group D had a substantial reduction in postoperative NRS ratings and a heightened degree of recovery from sedation, as shown by the RASS. Furthermore, it was noted that group D had a significantly reduced overall analgesic dose (9.12±0.46 vs. 6.24±1.37 mg; p= 0.02) and a prolonged duration until first analgesia (6.21±1.28 vs. 7.13±1.79 hours; p< 0.001). Conclusion: The use of dexmedetomidine in combination with levobupivacaine ESPB has been shown to enhance postoperative analgesia compared to the use of levobupivacaine alone. This improvement in postoperative analgesia leads to enhanced comfort levels for patients. Further research is necessary to corroborate these results via future studies conducted in several places.

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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

Cited by 15 publications

References 24 publications

Dexmedetomidine as an Adjuvant in Peripheral Nerve Block

Dexmedetomidine as an Adjuvant in Peripheral Nerve Block

Efficacy and Safety of Pectoral Nerve Block (Pecs) Compared With Control, Paravertebral Block, Erector Spinae Plane Block, and Local Anesthesia in Patients Undergoing Breast Cancer Surgeries

Analgesic Efficacy of Dexmedetomidine as Adjuvant to Levo-Bupivacine in Ultrasound Guided Erector Spinae Plan Block for Modified Radical Mastectomy

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