Efficacy of dexmedetomidine as an adjuvant in erector spinae plane block in breast cancer surgery: a randomized controlled trial

Abstract

Background: The erector spinae plane block (ESPB) is a new potential inter-fascial block technique used to decrease pain after breast surgery. Dexmedetomidine (Dex) is used as an adjuvant to local anesthetics and is thought to improve the analgesic profile and duration of different anesthetic techniques. We evaluated the effect of adding Dex in local anesthetic solution for ESPB in breast cancer surgeries regarding the analgesic effect and duration. Methodology: This prospective randomized controlled study included 60 female patients scheduled for breast cancer surgery. All patients were anesthetized in a standard manner, and then were randomized into three equal groups; 1. ESP group, to receive an ultrasound-guided ESPB with 20 ml bupivacaine 0.5%; 2. Dex group, to receive ESPB with 19 ml bupivacaine 0.5% and 1 ml of normal saline containing 1 μg/kg Dex, and the control group received the standard general anesthesia only. The intraoperative fentanyl and postoperative morphine consumption were noted. Postoperative pain was assessed on numerical pain rating scale (NRS) Results: The duration of analgesia was significantly prolonged in ESPB and Dex groups than in the control group and in the Dex group than in ESPB group (P < 0.001). Intraoperative fentanyl and postoperative morphine consumption were significantly lower in ESPB and Dex groups than in the control group. NRS pain scores were comparable in the three groups during the first 24 h. Conclusions: Adding dexmedetomidine 1 μg/kg to bupivacaine 0.5% prolongs the duration of analgesia of the ESPB in breast cancer surgeries.