Dexmedetomidine versus dexamethasone as adjunct to ropivacaine in erector spinae plane block for patients undergoing breast surgery: a randomized, prospective, double blinded study

Abstract

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.

Dexamethasone versus Dexmedetomidine as Adjuvant to Bupivacaine in Ultrasound Guided Erector Spinae Plane Block for Analgesia in Total Abdominal Hysterectomy

“…However, Basing et al (17) results were not similar to ours. They conducted a study comparing dexmedetomidine and dexamethasone as additives to ropivacaine in erector spinae plane block for patients undergoing breast surgery and concluded that p value was > 0.05% between the 2 groups in their statistical analysis of VAS at different time points with median was 2 in both groups.…”

“…However Margulis et al (31) and Basing et al (17) contradict our results where they found that intraoperative opioid consumption was less in the dexmedetomidine group when compared to both the control and dexamethasone group when both drugs were used as adjuvant to (20) ml ropivacaine 0.5% in ultrasound guided interscalene block in arthroscopic shoulder surgery and there was no difference in total analgesic consumption and the demand for first rescue analgesia between the dexmedetomidine and dexamethasone group in their comparative study between dexmedetomidine and dexamethasone as adjunct to ropivacaine in erector spinae plane block for patients undergoing breast surgery respectively. This may be due to lower dexamethasone dose (4mg) in the 1st study and difference in dexmedetomidine dose they used (0.5ug/kg) in 2nd one.…”