Dexmedetomidine and Ropivacaine in Thoracic Epidural Anaesthesia for Breast Surgery- A Clinical Comparison With General Anaesthesia

Abstract

BACKGROUND General anaesthesia is the traditional standard technique for various breast surgery, but Thoracic Epidural Anaesthesia offers advantages like better haemodynamics, early recovery, less postoperative respiratory complications and good analgesia. The objective of this study is to evaluate the effectiveness of Thoracic Epidural Anaesthesia with Dexmedetomidine and Inj. Ropivacaine (0.5%) for breast surgery (MRM) with conventional general anaesthesia. MATERIALS AND METHODS With permission from Institutional Ethics Committee, forty consenting ASA Grades I and II patients posted for MRM were divided into two groups. In Group (TEA) Thoracic Epidural was performed in T4-T8 intervertebral space and 5 cm of epidural catheter was threaded. Inj. Ropivacaine 0.5% with Dexmedetomidine 1 µg/kg was injected into the epidural space in increments via the catheter to achieve the desired height. In Group (GA), patients were managed in conventional way with Glycopyrrolate (0.2 mg), Fentanyl (2 µg/kg) and Midazolam (0.05 mg/kg) for premedication induced with Inj. Propofol (2 mg/kg). Intubation and maintenance of relaxation thereafter was with Vecuronium. Anaesthesia maintained with N20:O2 in 60:40 ratio with Isoflurane 0.4-0.6% in IPPV. Towards the end of surgery, the patients received Ondansetron (4 mg) and Diclofenac (75 mg) infusion and reversed with Neostigmine (0.5 mg/kg) and 20 µg of Glycopyrrolate. Ringer's Lactate was used as maintenance fluid for both the groups. Monitoring of Pulse, NIBP, ECG, SpO2 and Respiration was done throughout surgery in both the groups. RESULTS Adequacy of anaesthesia, surgical condition, bleeding, post-anaesthesia recovery, untoward effects in the perioperative period and overall patient satisfaction were evaluated. CONCLUSION Thoracic epidural with 0.5% Ropivacaine in conjunction with Dexmedetomidine did offer an excellent perioperative outcome without any significant untoward effects.