Paravertebral block with morphine or dexmedetomidine as adjuvant to bupivacaine for post-operative analgesia in modified radical mastectomy: A prospective, randomised, double-blind study

Background: Lumpectomy (partial mastectomy) is associated with a severe postoperative pain that can lead to chronic pain. The use of analgesia is common for this pain management, however, can impose a number of side effects. Objective: The aim of this study is to evaluate side effects following postoperative analgesia use and the impact of clinical factors among partial mastectomy patients. Method: This cross-sectional study was conducted at (XXX) center for breast cancer that included patients undergoing lumpectomy. Following the surgery, patients were given morphine 1 mg/ml with 50 mg diclofenac at every 8-h for 3 days for the management of pain. The visual analogue scale was used to measure pain. Postoperative nausea and vomiting, dizziness and vertigo was evaluated in these patients. The effects of these events on pulse rate, blood pressure and incision size were then analyzed using standard package in R software. Result: Of 136 partial mastectomy patients, an average of 41% of the patients were presented with nausea and vertigo, respectively, 9% had dizziness and 29% had vomiting. The results from our study indicated that clinical parameters (blood pressure, pulse rate and incision size) were not significantly associated with postoperative pain and dizziness p > 0.1. However, blood pressure and pulse are significantly associated with postoperative nausea and vertigo. Conclusion: The findings from our study indicate that hemodynamic variations are likely to be associated with analgesia-associated side effects. Future studies involving other parameters and risk factors can provide detailed outcomes. Highlights:

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A cross-sectional study on the postoperative analgesic-associated side effects and clinical parameters following partial mastectomy

Alizadeh

Aghsaeifard

Alavi

et al. 2020

International Journal of Surgery Open

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Post-operative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review

et al. 2021

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Background Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. Methods A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. Results Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. Conclusion We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries. Post Operative Pain Management Modalities Employed in Clinical Trials for Adult Patients in LMIC; A Systematic Review.

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Effects of fentanyl and dexmedetomidine as adjuvants to bupivacaine in paravertebral block for postoperative analgesia in patients undergoing modified radical mastectomy: A prospective randomised double-blind study

Pani

Sahu

Swain

et al. 2022

Indian Journal of Anaesthesia

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Background and Aims Paravertebral block (PVB) is an established method, indicated for postoperative analgesia after modified radical mastectomy (MRM). Although many additives to bupivacaine in PVB have been tried to prolong the analgesia in postoperative period, no additive has been found without any adverse effects. We have compared the duration of analgesia in PVB using adjuvants like dexmedetomidine and fentanyl with bupivacaine after MRM. Methods A total of 60 female patients enroled for MRM were divided into two groups of 30 patients each. Group BF received PVB with 20 ml bupivacaine 0.25% with fentanyl 1 mg/kg and group BD received 20 ml bupivacaine 0.25% with dexmedetomidine 1 mg/kg for PVB. After confirming successful PVB, surgery was done under general anaesthesia. Time for first rescue analgesic request was the primary outcome of the study. The secondary outcome was comparison of visual analogue scale scores for pain and total analgesic consumption. Side effects like sedation, nausea, vomiting, bradycardia and hypotension in the postoperative period till 24 h were also assessed. Results The time for first rescue analgesic request was 6.32 ± 1.75 h in the BD group contrary to 3.94 ± 2.12 h in group BF (P < 0.05). Total paracetamol consumed as rescue analgesia in the first 24 h of postoperative period was remarkably reduced in group BD (1.7 ± 0.94 gm) in contrary to group BF (2.6 ± 0.98 gm) (P < 0.05). There was no significant difference in the incidence of complications between the groups. Conclusion Dexmedetomidine provides prolonged postoperative analgesia compared with fentanyl when used as an adjuvant to bupivacaine in PVB after MRM.

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Paravertebral block with morphine or dexmedetomidine as adjuvant to bupivacaine for post-operative analgesia in modified radical mastectomy: A prospective, randomised, double-blind study

Cited by 5 publications

References 14 publications

A cross-sectional study on the postoperative analgesic-associated side effects and clinical parameters following partial mastectomy

A cross-sectional study on the postoperative analgesic-associated side effects and clinical parameters following partial mastectomy

Post-operative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review

Effects of fentanyl and dexmedetomidine as adjuvants to bupivacaine in paravertebral block for postoperative analgesia in patients undergoing modified radical mastectomy: A prospective randomised double-blind study

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