title: Dexmedetomidine as an adjunctive analgesic with bupivacaine in paravertebral analgesia for breast cancer surgery.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  A randomized, double-blind trial.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  This study is limited by its sample size.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesia, Intensive Care, and Pain Management, South Egypt Cancer Institute, Assiut University, Assiut, Egypt; Department of Biostatistics and Cancer Epidemiology, National Cancer Institute, Cairo University, Egypt.
authors.forename: Sahar A
authors.initials: SA
authors.lastname: Mohamed
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Fares
authors.forename: Ashraf Amin
authors.initials: AA
authors.lastname: Mohamed
authors.forename: Nelly H
authors.initials: NH
authors.lastname: Alieldin
mesh_terms: D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D000779:Anesthetics, Local / Q000009:adverse effects / Q000494:pharmacology*; D001943:Breast Neoplasms / Q000601:surgery; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015411:Mastectomy, Modified Radical / Q000379:methods*; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D013900:Thoracic Nerves / Q000187:drug effects; D013904:Thoracic Vertebrae; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000779:Anesthetics, Local; D020927:Dexmedetomidine; D002045:Bupivacaine