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.
 Key words: Analgesia; Breast Cancer; Breast Surgery; Bupivacaine; Dexmedetomidine; Nerve Block
 Citation: Hassan ME, Abdelgalil AS. Efficacy of dexmedetomidine as an adjuvant in erector spinae plane block in breast cancer surgery: a randomized controlled trial. Anaesth. pain intensive care 2022;27(1):16−22; DOI: 10.35975/apic.v27i1.2109
 Received August 16, 2022; Reviewed: November 13, 2022; Accepted: December 03, 2022

Dexmedetomidine with different concentrations added to local anesthetics in erector spinae plane block: a meta-analysis of randomized controlled trials

“…The blocks provided surgical anesthesia in all 13 trials ( 7 – 9 , 34 – 43 ). All trials used long-acting LAs, including levobupivacaine in one trial ( 43 ), bupivacaine in three trials ( 37 , 40 , 41 ), and ropivacaine in nine trials ( 7 – 9 , 34 – 36 , 38 , 39 , 42 ). DEX was used at a concentration of 0.5 μg/kg in three trials ( 9 , 37 , 40 ), 1 μg/kg in nine trials ( 7 , 8 , 34 – 36 , 38 , 41 – 43 ), and both concentrations in one trial ( 39 ).…”

“…All trials used long-acting LAs, including levobupivacaine in one trial ( 43 ), bupivacaine in three trials ( 37 , 40 , 41 ), and ropivacaine in nine trials ( 7 – 9 , 34 – 36 , 38 , 39 , 42 ). DEX was used at a concentration of 0.5 μg/kg in three trials ( 9 , 37 , 40 ), 1 μg/kg in nine trials ( 7 , 8 , 34 – 36 , 38 , 41 – 43 ), and both concentrations in one trial ( 39 ). Among them, four trials ( 7 , 34 , 38 , 43 ) also examined other adjuvants such as nalbuphine and dexamethasone, which arms were excluded from our analysis as unsuitable for the inclusion criteria.…”

“…Dynamic pain scores at 12 h and 24 h postoperatively were available from eight trials (295 patients in the DEX group and 258 patients in the control group) and are shown in Figure 4 ( 7 – 9 , 35 , 39 – 41 , 43 ). Compared to the control groups, dexmedetomidine as an adjuvant to ESPB reduced the dynamic postoperative pain severity at 12 h at concentrations of 0.5 μg/kg (MD = −0.55; 95% CI: −0.95, −0.15; p = 0.007; I 2 = 49%; p = 0.14) and 1 μg/kg (MD = −0.66; 95% CI: −1.05, −0.28; p = 0.0006; I 2 = 73%; p = 0.003).…”

“…Nine studies included the outcome of the time to first analgesia, including three trials ( 9 , 37 , 40 ) with 0.5 μg/kg DEX concentration, five trials ( 7 , 34 , 38 , 41 , 43 ) with 1 μg/kg DEX concentration, and one trial ( 39 ) with both low and high concentrations. In the subgroup that received low concentration of dexmedetomidine, the time to first analgesia requirement was prolonged by 4.07 h (95% CI:1.99, 6.16; p = 0.0001; I 2 = 90%; p < 0.00001); in the high concentration of dexmedetomidine subgroup, it was prolonged by 7.79 h (95% CI: 4.36, 11.22; p < 0.00001; I 2 = 92%; p < 0.00001; Figure 6 ).…”

“…Morphine was used for postoperative analgesia in five trials—two ( 37 , 40 ) with low concentration and three ( 36 , 41 , 43 ) with high. Compared to the control groups, the consumption of morphine in the DEX groups with low concentration was reduced by 1.07 mg (95% CI: −2.06, −0.09; p = 0.03; I 2 = 0%; p = 0.99); in the high concentration subgroup, the consumption of morphine was reduced by 2.25 mg (95% CI: −2.95, −1.54, p < 0.00001; I 2 = 0%; p = 0.66; Figure 7 ).…”