Efficacy of dexmedetomidine as an adjuvant with ropivacaine in USG guided erector spinae plane block for modified radical mastectomy surgery- prospective randomized double blind controlled study

Background and Aims: Modified radical mastectomy (MRM) is associated with considerable acute postoperative pain and even chronic persistent pain. Erector spinae plane block (ESPB) is interfascial block for thoracic analgesia. This study was planned to evaluate efficacy of dexmedetomidine as adjuvant with ropivacaine in ESPB for postoperative analgesia in MRM surgery. Materials and Methods: In this prospective randomized double-blind controlled study, 60 American Society of Anesthesiologists Grade I and II female patients, aged 18–60 years scheduled for MRM surgery under general anesthesia were randomly allocated into Group R and RD to receive ultrasound (USG)-guided ESPB with 20 ml 0.375% ropivacaine and 1 μg/kg dexmedetomidine added to 20 ml 0.375% ropivacaine, respectively. Visual Analog Score (VAS) was recorded at 0, 2, 4, 6, 8, 10, 12, and 24 h postoperatively. Duration of analgesia together with total number and amount of analgesic drug required was recorded in first 24 h postoperatively. Patient's satisfaction score was recorded on 10-point scale. Chi-square test, t-test, and Wilcoxon signed-rank test were applied where deemed appropriate. P <0.05 was considered statistically significant. Results: VAS score was less in Group RD at all measured time points postoperatively. Duration of analgesia was prolonged in Group RD (683.00 ± 83.99 min vs. 620.63 ± 70.42 min). Total number and amount of intravenous diclofenac (rescue analgesic) was lower in Group RD (1.13 ± 0.57 vs. 1.46 ± 0.57, 85.00 ± 42.85 vs. 110.00 ± 42.85). Patients in group RD were better satisfied with their anesthesia experience (8 [8–9] vs. 8 [7–8], P = 0.00194). Group RD demonstrated a lower heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure intraoperatively. Conclusion: Dexmedetomidine as an adjuvant to ropivacaine in USG-guided ESPB for MRM surgery leads to lower postoperative pain scores, prolongs postoperative analgesia, reduces postoperative rescue analgesics requirements, and provides better hemodynamic stability and good patient satisfaction.