Ultrasound PECS 2 Versus Dexmedetomidine Infusion for Pain Management after Radical Mastectomy
Mohamed Ahmed Shoman *
El-Mahalla General Hospital, El-Gharbeya, Egypt.
Mohamed Ahmed Lofty Ibrahim
Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Ashraf Al-Sayed Al-Zeftawy
Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Atteia Gad Ibrahim
Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
*Author to whom correspondence should be addressed.
Abstract
Background: Pectoralis-Serratus interfascial plane block is a peripheral block of the thoracic wall that presents analgesia of its anterolateral portion. Dexmedetomidine, a specific α-2 adrenoceptor agonist, has sedative, anxiolytic, and analgesic properties. The aim of this work was to assess the analgesic safety and efficacy of Pectoralis-Serratus interfascial plane block in contrast with dexmedetomidine infusion for unilateral radical mastectomy.
Methods: This prospective randomized study was carried out on 60 adult patients with American Society of Anaesthesiologists (ASA) physical status I/II scheduled for elective unilateral radical mastectomy. The cases were classified randomly into two equal groups: group I: received ultrasound guided pectoralis serratus interfacial plane block and group II: received dexmedetomidine infusion. All patients were subjected to routine laboratory investigations (coagulation profile, CBC, liver and renal function tests) and visual analogue scale (VAS).
Results: Total amount of fentanyl increments, Ramsey sedation score and total analgesic (morphine) consumption in the 1st 24 hours postoperative were significantly decreased in group I contrasted to group II (P<0.001). Time of the first rescue analgesia was significantly increased in group I than group II (P <0.001). Bradycardia was considerably decreased in group I than group II (P = 0.026). VAS at rest and at exercise were significantly decreased at 1, 2, 4 and 6 hours in group I than group II (P<0.05).
Conclusions: PECS-II blocks are superior to dexmedetomidine infusion provide adequate post-operative analgesia (lower VAS and total analgesic consumption with increased 1st rescue analgesia) with hemodynamic stability. and less complications.
Keywords: Ultrasound PECS 2, dexmedetomidine infusion, pain management, radical mastectomy