Raj Priyanka, Sinha Nitesh, Kharwar Ramesh K, Singh Dipali, Kumar Sourabh, Priye Shio, Prakash Jay
Department of Anesthesiology, Rajendra Institute of Medical Sciences, Ranchi, Ranchi, IND.
Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Ranchi, IND.
Cureus. 2024 Jul 30;16(7):e65727. doi: 10.7759/cureus.65727. eCollection 2024 Jul.
Background and aim While the infiltration of surgical incisions with local anesthetics is not a new practice, it remains a crucial component of contemporary multimodal analgesia protocols. This study aimed to evaluate the efficacy and safety of using adjuvants in combination with local anesthetic wound infiltration for pain management in patients undergoing mastectomy surgery. Methods Eighty-one patients aged 18-60 years, classified as American Society of Anesthesiologists (ASA) grade I or II, were scheduled for unilateral mastectomy and randomly assigned to three groups of 27 each. The groups were designated as Group C (bupivacaine alone), Group D (bupivacaine with dexmedetomidine), and Group K (bupivacaine with ketamine). Group C received 0.25% bupivacaine alone, Group D received 0.25% bupivacaine with 1 mcg/kg dexmedetomidine, and Group K received 0.25% bupivacaine with 1 mg/kg ketamine. The time to achieve a Visual Analogue Scale (VAS) score of 3 following local wound infiltration was recorded for each group. Additionally, total postoperative fentanyl intake during the first 24 hours, as measured by the patient-controlled analgesia (PCA) pump, was compared among the groups. Sedation levels were assessed using the Ramsay Sedation Scale (RSS). Data were analyzed using the Chi-Square test and one-way ANOVA in IBM SPSS Statistics for Windows, Version 28.0 (Released 2021; IBM Corp., Armonk, NY, USA). Results Demographic factors were similar across the three groups. Analysis of the VAS scores revealed that the ketamine group provided better postoperative pain control than the dexmedetomidine group (p < 0.001). Groups D (71.72 ± 71.73) and K (3.53 ± 13.42) had significantly lower 24-hour fentanyl intake (in mcg) compared to Group C (the control group), as measured by PCA. Additionally, Group C had a significantly lower RSS at the sixth hour (p = 0.003) compared to both Groups D and K. Conclusion Ketamine, when used as an adjuvant to bupivacaine for local infiltration, enhances the effectiveness and prolongs postoperative analgesia more effectively than dexmedetomidine in patients undergoing mastectomy.
背景与目的 虽然在手术切口中浸润局部麻醉剂并非新的做法，但它仍然是当代多模式镇痛方案的关键组成部分。本研究旨在评估在接受乳房切除术的患者中，辅助药物与局部麻醉剂伤口浸润联合使用进行疼痛管理的有效性和安全性。方法 81例年龄在18 - 60岁、美国麻醉医师协会（ASA）分级为I或II级的患者计划接受单侧乳房切除术，并随机分为三组，每组27例。三组分别为C组（仅用布比卡因）、D组（布比卡因与右美托咪定）和K组（布比卡因与氯胺酮）。C组仅接受0.25%布比卡因，D组接受0.25%布比卡因加1 mcg/kg右美托咪定，K组接受0.25%布比卡因加1 mg/kg氯胺酮。记录每组局部伤口浸润后达到视觉模拟评分（VAS）3分的时间。此外，比较各组患者自控镇痛（PCA）泵在术后24小时内芬太尼的总摄入量。使用Ramsay镇静评分（RSS）评估镇静水平。在IBM SPSS Statistics for Windows 28.0版（2021年发布；IBM公司，美国纽约州阿蒙克）中使用卡方检验和单因素方差分析对数据进行分析。结果 三组的人口统计学因素相似。对VAS评分的分析显示，氯胺酮组术后疼痛控制优于右美托咪定组（p < 0.001）。通过PCA测量，D组（71.72 ± 71.73）和K组（3.53 ± 13.42）的24小时芬太尼摄入量（以mcg计）显著低于C组（对照组）。此外，C组在第6小时的RSS显著低于D组和K组（p = 0.003）。结论 在接受乳房切除术的患者中，氯胺酮作为布比卡因局部浸润的辅助药物，比右美托咪定更有效地增强了有效性并延长了术后镇痛时间。
