scholarly journals Dexmedetomidine as an Adjunctive Analgesic with Bupivacaine in Paravertebral Analgesia for Breast Cancer Surgery

2014 ◽  
Vol 5;17 (5;9) ◽  
pp. E589-E598 ◽  
Author(s):  
Sahar A. Mohamed
Keyword(s):  
Breast Cancer ◽  
Blood Pressure ◽  
Side Effects ◽  
Pulse Rate ◽  
Radical Mastectomy ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Postanesthesia Care Unit ◽  
Modified Radical Mastectomy ◽  
Group B

Background: There is little systematic research on the efficacy and tolerability of the addition of adjunctive analgesic agents in paravertebral analgesia. The addition of adjunctive analgesics, such as fentanyl and clonidine, to local anesthetics has been shown to enhance the quality and duration of sensory neural blockades, and decrease the dose of local anesthetic and supplemental analgesia. Objectives: Investigation of the safety and the analgesic efficacy of adding 1 µg/kg dexmedetomidine to bupivacaine 0.25% in thoracic paravertebral blocks (PVB) in patients undergoing modified radical mastectomy. Study Design: A randomized, double-blind trial. Setting: Academic medical center. Methods: Sixty American Society of Anesthesiologists physical status –I – III patients were randomly assigned to receive thoracicPVB with either 20 mL of bupivacaine 0.25% (Group B, n = 30), or 20 mL of bupivacaine 0.25% + 1 µg/kg dexmedetomidine (Group BD, n= 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 48 hours. Results: There was a significant reduction in pulse rate and diastolic blood pressure starting at 30 minutes in both groups, but more evidenced in group BD (P < 0.001). Intraoperative Systolic blood pressure showed a significant reduction at 30 minutes in both groups (P < 0.001) then returned to baseline level at 120 minutes in both groups. There was a significant increase in pulse rate starting 2 hours postoperative until 48 hours postoperatively in group B but only after 12 hours until 48 hours in group BD (P < 0.001). The time of the first rescue analgesic requirement was significantly prolonged in the group BD (8.16 ± 42 hours) in comparison to group B (6.48 ± 5.24 hours) (P = 0.04). The mean total consumption of intravenous tramadol rescue analgesia in the postanesthesia care unit in the firtst 48 hours postoperatively was significantly decreased in group BD (150.19 ± 76.98 mg) compared to group B (194.44 ± 63.91 mg) (P = 0.03). No significant serious adverse effects were recorded during the study. Limitations: This study is limited by its sample size. Conclusion: The addition of dexmedetomidine 1 µg/kg to bupivacaine 0.25% in thoracic PVB in patients undergoing modified radical mastectomy improves the quality and the duration of analgesia and also provides an analgesic sparing effect with no serious side effects. Key words: Dexmedetomidine, paravertebral block, postoperative analgesia, breast cancer surgery

Comparison of Efficacy of I/V Tramadol and Bupivacaine Irrigation through Drains after Modified Radical Mastectomy

2021 ◽  
Vol 15 (11) ◽  
pp. 3007-3011
Author(s):  
Zarqa Rani ◽  
Iqra Mushtaq ◽  
Mehreen Akram ◽  
Zahra Ishrat
Keyword(s):  
Breast Cancer ◽  
Urinary Retention ◽  
Controlled Trial ◽  
Radical Mastectomy ◽  
Breast Cancer Surgery ◽  
Modified Radical Mastectomy ◽  
Increased Risk ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Severe postsurgical pain continues to be hard to manage in patients who experience breast cancer surgery. Badly managed pain can lead to meager patient satisfaction, prolonged hospital stay, and increased risk of complication by analgesics, and may be a reason in the development of long-lasting pain. Aim: To compare the efficacy of Intravenous Tramadol and Bupivacaine irrigation through surgical drains after Modified Radical Mastectomy in patients with carcinoma breast. Methods: This was a randomized controlled trial conducted in the Department of Anesthesia, Mayo Hospital Lahore. Total 70 female patients aged 18-70 years undergoing radical mastectomy for CA breast diagnosed on histopathology were selected. Patients were divided into two groups A and B through simple random sampling technique. Group A received intravenous Tramadol. Group B received Bupivacaine through surgical drains. Results: At 0, 2, 4 and 6 hour postoperatively no significant difference was seen in severity of pain in both treatment groups. In Group-A at 0, 2, 4 and 6 hour postoperatively, 68.8%, 71.4%, 57.1% and 60% respectively had reported no pain while in Group-B at 0, 2, 4 and 6 hour postoperatively, 48.6%, 65.7%, 45.7% and 54.3% patients had reported no pain. Complaints of Nausea, vomiting, sedation, urinary retention was higher in patients in Tramadol Group as compared to Bupivacaine Group. Conclusion: Results of this study demonstrated that bupivacaine administrated through surgical drain was equally effective as intravenous tramadol for controlling postoperative mastectomy pain with less side effects. Keyword: Breast Cancer, Acute Pain, Analgesia, Tramadol, Bupivacaine, Radical Mastectomy, Nausea, Vomiting, Sedation, Urinary retention, Hypotension

scholarly journals Effects of breast cancer surgery and surgical side effects on body image over time

2010 ◽  
Vol 126 (1) ◽  
pp. 261-262 ◽  
Author(s):  
Alexandre Mendonça Munhoz ◽  
Rolf Gemperli ◽  
José Roberto Filassi
Keyword(s):  
Breast Cancer ◽  
Body Image ◽  
Side Effects ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Over Time

Effect of Dexmedetomidine Added to Modified Pectoral Block on Postoperative Pain and Stress Response in Patient Undergoing Modified Radical Mastectomy

2018 ◽  
Vol 1 (21;1) ◽  
pp. E87-E96 ◽  
Author(s):  
Fatma A. El Sherif
Keyword(s):  
Blood Pressure ◽  
Stress Response ◽  
Side Effects ◽  
Postoperative Pain ◽  
Radical Mastectomy ◽  
Morphine Consumption ◽  
Surgical Trauma ◽  
Modified Radical Mastectomy ◽  
Rescue Analgesia ◽  
Vas Scores

Background: The most common surgical procedure for breast cancer is the modified radical mastectomy (MRM), but it is associated with significant postoperative pain. Regional anesthesia can reduce the stress response associated with surgical trauma. Objectives: Our aim is to explore the efficacy of 1 µg/kg dexmedetomedine added to an ultrasound (US)-modified pectoral (Pecs) block on postoperative pain and stress response in patients undergoing MRM. Study Design: A randomized, double-blind, prospective study. Setting: An academic medical center. Methods: Sixty patients with American Society of Anesthesiologists (ASA) physical status I– II (18–60 years old and weighing 50–90 kg) scheduled for MRM were enrolled and randomly assigned into 2 groups (30 in each) to receive a preoperative US Pecs block with 30 mL of 0.25% bupivacaine only (group 1, bupivacaine group [GB]) or 30 mL of 0.25% bupivacaine plus 1 µg/ kg dexmedetomidine (group II, dexmedetomidine group [GD]). The patients were followed-up 48 hours postoperatively for vital signs (heart rate [HR], noninvasive blood pressure [NIBP], respiratory rate [RR], and oxygen saturation [Sao2]), visual analog scale (VAS) scores, time to first request of rescue analgesia, total morphine consumption, and side effects. Serum levels of cortisol and prolactin were assessed at baseline and at 1 and 24 hours postoperatively. Results: A significant reduction in the intraoperative HR, systolic blood pressure (SBP), and diastolic blood pressure (DBP) starting at 30 minutes until 120 minutes in the GD group compared to the GB group (P < 0.05) was observed. The VAS scores showed a statistically significant reduction in the GD group compared to the GB group, which started immediately up until 12 hours postoperatively (P < 0.05). There was a delayed time to first request of analgesia in the GD group (25.4 ± 16.4 hrs) compared to the GB group (17 ± 12 hrs) (P = 0.029), and there was a significant decrease of the total amount of morphine consumption in the GD group (9 + 3.6 mg) compared to the GB group (12 + 3.6 mg) (P = 0.001). There was a significant reduction in the mean serum cortisol and prolactin levels at 1 and 24 hours postoperative in the GD patients compared to the GB patients (P < 0.05). Limitations: This study was limited by its sample size. Conclusion: The addition of 1 µg/kg dexmedetomidine to an US-modified Pecs block has superior analgesia and more attenuation to stress hormone levels without serious side effects, compared to a regular Pecs block in patients who underwent MRM. Key words: Postoperative pain, dexmedetomidine, Pecs block, stress response, breast surgery

scholarly journals Effects of breast cancer surgery and surgical side effects on body image over time

2010 ◽  
Vol 126 (1) ◽  
pp. 167-176 ◽  
Author(s):  
Karen Kadela Collins ◽  
Ying Liu ◽  
Mario Schootman ◽  
Rebecca Aft ◽  
Yan Yan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Body Image ◽  
Side Effects ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Over Time

scholarly journals Pectoralis-II Myofascial Block and Analgesia in Breast Cancer Surgery

2019 ◽  
Vol 131 (3) ◽  
pp. 630-648 ◽  
Author(s):  
Nasir Hussain ◽  
Richard Brull ◽  
Colin J. L. McCartney ◽  
Patrick Wong ◽  
Nicolas Kumar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Area Under Curve ◽  
Relative Effectiveness ◽  
Cancer Surgery ◽  
Paravertebral Block ◽  
Morphine Consumption ◽  
Breast Cancer Surgery ◽  
Rest Pain ◽  
Pain Area

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Thoracic paravertebral block is the preferred regional anesthetic technique for breast cancer surgery, but concerns over its invasiveness and risks have prompted search for alternatives. Pectoralis-II block is a promising analgesic technique and potential alternative to paravertebral block, but evidence of its absolute and relative effectiveness versus systemic analgesia (Control) and paravertebral block, respectively, is conflicting. This meta-analysis evaluates the analgesic effectiveness of Pectoralis-II versus Control and paravertebral block for breast cancer surgery. Methods Databases were searched for breast cancer surgery trials comparing Pectoralis-II with Control or paravertebral block. Postoperative oral morphine consumption and difference in area under curve for pooled rest pain scores more than 24 h were designated as coprimary outcomes. Opioid-related side effects, effects on long-term outcomes, such as chronic pain and opioid dependence, were also examined. Results were pooled using random-effects modeling. Results Fourteen randomized trials (887 patients) were analyzed. Compared with Control, Pectoralis-II provided clinically important reductions in 24-h morphine consumption (at least 30.0 mg), by a weighted mean difference [95% CI] of −30.5 mg [−42.2, −18.8] (P &lt; 0.00001), and in rest pain area under the curve more than 24 h, by −4.7cm · h [−5.1, −4.2] or −1.2cm [−1.3, −1.1] per measurement. Compared with paravertebral block, Pectoralis-II was not statistically worse (not different) for 24-h morphine consumption, and not clinically worse for rest pain area under curve more than 24 h. No differences were observed in opioid-related side effects or any other outcomes. Conclusions We found that Pectoralis-II reduces pain intensity and morphine consumption during the first 24 h postoperatively when compared with systemic analgesia alone; and it also offers analgesic benefits noninferior to those of paravertebral block after breast cancer surgery. Evidence supports incorporating Pectoralis-II into multimodal analgesia and also using it as a paravertebral block alternative in this population.

scholarly journals Efficacy and Safety of Ketamine Added to Local Anesthetic in Modified Pectoral Block for Management of Postoperative Pain in Patients Undergoing Modified Radical Mastectomy

2016 ◽  
Vol 7;19 (7;9) ◽  
pp. 485-494
Author(s):  
Fatma Adel El Sherif
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Postoperative Pain ◽  
Nerve Block ◽  
Radical Mastectomy ◽  
Morphine Consumption ◽  
Efficacy And Safety ◽  
Modified Radical Mastectomy ◽  
Ultrasound Guided ◽  
Significant Difference

Background: Breast surgery is an exceedingly common procedure with an increased incidence of acute and chronic pain. Pectoral nerve block is a novel peripheral nerve block alternative to neuro-axial and paravertebral blocks for ambulatory breast surgeries. Objectives: This study aims to compare the analgesic efficacy and safety of modified Pecs block with ketamine plus bupivacaine versus bupivacaine in patients undergoing breast cancer surgery. Study Design: A randomized, double-blind, prospective study. Setting: Academic medical center. Methods: This study is registered at www.clinicaltrials.gov under number: (NCT02620371) after approval by the ethics committee of South Egypt Cancer Institute, Assuit University, Assuit, Egypt. Sixty patients aged 18 – 60 years scheduled for modified radical mastectomy were enrolled and randomly assigned into 2 groups (30 patients each): Control group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25% bupivacaine only. Ketamine group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25% bupivacaine plus ketamine hydrochloride (1 mg/kg). Patients were followed up for 48 hours postoperatively for vital signs, VAS score, first request of rescue analgesia and total morphine consumption, sedation score, and side effects. Results: Ketamine plus bupivacaine in Pecs block compared to bupivacaine alone prolonged the mean time of first request of analgesia (18.25 ± 1.98), (12.56 ± 2.64), respectively (P < 0.001), reduced total morphine consumption (12.50 ± 4.63), (18.86 ± 6.28), respectively (P = 0.016). With no significant difference in hemodynamics, respiratory rate, oxygen saturation, VAS and sedation scores, and side effects observed between the 2 groups (P > 0.05). Limitations: This study is limited by its sample size. Conclusion: The addition of ketamine to modified Pecs block prolonged the time to first request of analgesia and reduced total opioid consumption without serious side effects in patients who underwent a modified radical mastectomy. Key words: Ketamine, bupivacaine, pecs block, postoperative, pain, breast cancer

Effects of breast cancer surgery and surgical side effects on body image over time

2010 ◽  
Vol 126 (1) ◽  
pp. 263-264 ◽  
Author(s):  
Karen Kadela Collins ◽  
Maria Pérez ◽  
Mario Schootman ◽  
Rebecca Aft ◽  
Donna B. Jeffe
Keyword(s):  
Breast Cancer ◽  
Body Image ◽  
Side Effects ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Over Time

Effects of Clonidine on Postoperative Nausea and Vomiting in Breast Cancer Surgery

2002 ◽  
Vol 96 (5) ◽  
pp. 1109-1114 ◽  
Author(s):  
Eva Oddby-Muhrbeck ◽  
Staffan Eksborg ◽  
Henrik T. G. Bergendahl ◽  
Olle Muhrbeck ◽  
Per Arne Lönnqvist
Keyword(s):  
Breast Cancer ◽  
Blood Pressure ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Cancer Surgery ◽  
Nausea And Vomiting ◽  
Breast Cancer Surgery ◽  
Number Needed To Treat ◽  
Double Blind Study ◽  
Double Blind

Background Postoperative nausea and vomiting (PONV) is still common, especially among female patients. Our hypothesis is that coinduction with clonidine reduces the incidence of PONV in adult patients undergoing breast cancer surgery. Methods Sixty-eight women premedicated with midazolam were randomly allocated to coinduction with intravenous clonidine (group C) or placebo (group P) in this prospective, double-blind study. Anesthesia was standardized (laryngeal mask airway, fentanyl, propofol, sevoflurane, nitrous oxide, and oxygen). Hemodynamic parameters and the requirements for propofol, sevoflurane, and the postoperative need for ketobemidone were noted. The primary endpoints studied were the number of PONV-free patients and patient satisfaction with respect to PONV. Results Patients in group C had a significantly reduced need for propofol (P &lt; 0.04) and sevoflurane (P &lt; 0.01) and a reduced early need for ketobemidone (P &lt; 0.04). There were significantly more PONV-free patients in group C compared with group P (20 and 11 of 30, respectively; P &lt; 0.04). The number needed to treat was 3.3 (95% confidence interval, 1.8, 16.9). Intraoperative blood pressure, postoperative heart rate, and postoperative blood pressure were all significantly lower in group C compared with group P, but were not considered to be of clinical importance. No negative side effects were recorded. Conclusion Coinduction with clonidine significantly increased the number of PONV-free patients after breast cancer surgery with general anesthesia.

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