Department of Anaesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University.
Internship at Ain Shams University Hospitals, Medical College, Ain Shams University Hospitals, Cairo, Egypt.
Clin J Pain. 2022 Sep 1;38(9):568-574. doi: 10.1097/AJP.0000000000001055.
Pectoralis and serratus plane blocks (Pecs-II block) has successfully demonstrated a good quality of perioperative analgesia for breast surgery.
This study aimed to compare the quality of postoperative pain control when adding either ketamine or dexmedetomidine to bupivacaine 0.25% for Pecs-II block.
This prospective randomized double-blind study was conducted on 159 female patients with American Society of Anesthesiologist (ASA) physical status class I-III scheduled to have modified radical mastectomy. Patients were randomly assigned into 3 groups. Each group included 53 patients to receive ultrasound guided Pecs-II blocks with either 32 mL of 0.25% bupivacaine added to ketamine hydrochloride 1 mg/kg (BK group), 32 mL of 0.25% bupivacaine added to dexmedetomidine 1 ug/kg (BD group) or 32 mL of 0.25% bupivacaine only (B group).The primary outcome was the total postoperative morphine consumption for the first 24 hours postoperatively. The time of the first request of analgesia, the pain scores at rest of ipsilateral arm, and the intraoperative fentanyl requirements, were the secondary outcome measures. Any side effects occurred were recorded.
The total postoperative morphine consumption was significantly lower in patients received bupivacaine with addition of either ketamine (BK group), (10.3±2.6 mg), or dexmedetomidine (BD group), (3.8±0.2 mg) respectively, versus patients received only bupivacaine (B group), (16.9±5.3 mg). Both ketamine (BK group) and dexmedetomidine (BD group) added to bupivacaine significantly prolonged the time to first analgesic request (16.7±4.5 h), (21.6±1.6 h) in both groups respectively compared with patients received bupivacaine alone (B group) (11.5±1.2 h).The pain score was variable between the 3 groups during the first 24 hours postoperatively. There were no statistically significant differences in perioperative hemodynamics, O 2 saturation, sedation scores, or side effects observed between the 3 groups. Patient satisfaction was reported to be the best in patients received dexmedetomidine added to bupivacaine compared to the patients who received ketamine as an additive or those who received bupivacaine alone.
Adding dexmedetomidine to bupivacaine provides more effective postoperative pain control than adding ketamine during Pecs-II blocks for breast cancer surgery.
胸肌和前锯肌平面阻滞（Pecs-II 阻滞）已成功证明在乳腺癌手术中具有良好的围手术期镇痛质量。
本研究旨在比较在 Pecs-II 阻滞中加入氯胺酮或右美托咪定与布比卡因 0.25% 相比，术后疼痛控制质量的差异。
这是一项前瞻性随机双盲研究，纳入了 159 名美国麻醉医师协会（ASA）身体状况 I-III 级的女性患者，计划接受改良根治性乳房切除术。患者被随机分为 3 组。每组包括 53 名患者，接受超声引导的 Pecs-II 阻滞，每组分别给予 32ml 0.25%布比卡因加盐酸氯胺酮 1mg/kg（BK 组）、32ml 0.25%布比卡因加右美托咪定 1μg/kg（BD 组）或仅给予 32ml 0.25%布比卡因（B 组）。主要结局是术后 24 小时内的总术后吗啡消耗量。次要结局指标包括首次请求镇痛的时间、同侧手臂休息时的疼痛评分和术中芬太尼需求。记录任何不良反应。
与仅接受布比卡因的患者（B 组）（16.9±5.3mg）相比，接受布比卡因加氯胺酮（BK 组）（10.3±2.6mg）或布比卡因加右美托咪定（BD 组）（3.8±0.2mg）的患者术后吗啡总消耗量明显降低。与仅接受布比卡因的患者（B 组）（11.5±1.2h）相比，布比卡因加氯胺酮（BK 组）和布比卡因加右美托咪定（BD 组）均显著延长了首次镇痛请求的时间（16.7±4.5h）和（21.6±1.6h）。在术后 24 小时内，3 组之间的疼痛评分存在差异。3 组之间的围手术期血流动力学、氧饱和度、镇静评分或不良反应无统计学差异。与接受氯胺酮或布比卡因的患者相比，接受右美托咪定的患者报告的患者满意度最高。
与单独使用布比卡因相比，在 Pecs-II 阻滞中加入右美托咪定可为乳腺癌手术提供更有效的术后疼痛控制。
