Efficacy of adding dexmedetomidine as adjuvant with levobupivacaine in ultrasound-guided serratus plane block for modified radical mastectomy surgery

Abstract

Background Women undergoing mastectomy experience severe pain postoperatively. Serratus plane block would be suitable for providing long-lasting regional anesthesia. This study was aimed to evaluate the effect of adding dexmedetomidine as adjuvant to levobupivacaine on the quality and duration of this block. Patients and methods Patients were randomly allocated to three equal groups after induction of general anesthesia. Levobupivacaine group (L) (n=50): received levobupivacaine 0.25% in a volume of 0.5 ml/kg injected superficial to serratus muscle between it and latissimus dorsi muscle. Levobupivacaine–dexmedetomidine group (D) (n=50): received levobupivacaine of 0.25% plus 0.5 mcg/kg dexmedetomidine in a volume of 0.5 ml/kg injected superficial to serratus muscle between it and latissimus dorsi muscle. Group C (n=50), as a control group: received sham block with normal saline in a volume of 0.5 ml/kg. Time to first analgesia request and postoperative opioid consumption were the primary outcomes. Results This study demonstrated that addition of dexmedetomidine to levobupivacaine in ultrasound-guided serratus plain block during modified radical mastectomy surgery delayed time of first analgesia request and reduced postoperative opioid consumption compared with levobupivacaine alone. Hemodynamic changes (hypotension and low heart rate) and sedation were more pronounced in dexmedetomidine group than the other two groups. Occurrence of nausea and vomiting in dexmedetomidine group is lower than the other two groups. Conclusion The addition of dexmedetomidine as an adjuvant to levobupivacaine in ultrasound-guided serratus plain block during modified radical mastectomy surgery can give extended analgesic effect and lower postoperative opioid consumption.