DefinePK

Abstract

Background & objective: Modified Radical Mastectomy (MRM) is typically performed under general anesthesia that often necessitates opioid administration, which can lead to side effects such as sedation, respiratory depression, and nausea. Fascial plane blocks, including the Erector Spinae Plane Block (ESPB), offer an effective analgesic alternative to opioids. This study aimed to assess the effectiveness of bi-level ESPB with either dexmedetomidine or dexamethasone as adjuvants to bupivacaine, compared with opioid-based analgesia, in patients undergoing MRM.
Methods: This randomized controlled study included female cancer patients scheduled for MRM. Patients were randomized into four groups; Group D (control group) received conventional anesthesia with intraoperative morphine, and the other three groups received bi-level ESPB at T2 and T4. Group A received ESPB with 0.25% bupivacaine, Group B received ESPB with 0.25% bupivacaine and 0.1 mg/kg dexamethasone, and Group C received ESPB with 0.25% bupivacaine and 0.5μg/kg dexmedetomidine.
Results: The time to first rescue morphine was significantly shorter in Group D compared with Groups A, B, and C (P < 0.001). Postoperative morphine consumption was significantly higher in group D than in the other groups (P < 0.001). Intraoperative fentanyl consumption was lower in Group C compared with the rest of the groups (P < 0.001).
Conclusions: In MRM, adding dexmedetomidine as an adjuvant to bupivacaine in ultrasound-guided bi-level ESPB showed a better analgesic profile compared to no adjuvant, dexamethasone, and conventional opioid analgesia with lower pain scores and lower intraoperative opioid consumption. However, dexmedetomidine and dexamethasone, when used as adjuvants, had a comparable effect to no adjuvant with respect to postoperative opioid consumption and the time to first analgesic administration.
Keywords: Dexmedetomidine; Dexamethasone; Modified Radical Mastectomy; Analgesia; Morphine.
Citation: Shehab NN, Fahmy RM, Abdelrahman AS, Omran AF, Elsabeeny WY. Analgesic efficacy of adding adjuvants to local anesthetics in bi-level erector spinae plane block for breast surgeries: a randomized controlled study. Anaesth. Pain Intensive Care 2025;29(6):787-795. DOI: 10.35975/apic.v29i6.2979.
Received: April 16, 2025; Revised: August 02, 2025; Accepted: August 05, 2025