Background: Mastectomy is associated with postoperative pain that can become chronic if left untreated. While opioids are commonly used, their adverse effects on recovery highlight the need for alternative methods. This study investigates the opioid-sparing effects of adding dexmedetomidine to ropivacaine, compared to ropivacaine without dexmedetomidine, in erector spinae plane block for patients undergoing mastectomy. Methods: This is a prospective, randomized controlled trial conducted at a tertiary University Hospital. Forty-four patients undergoing mastectomy with axillary lymph node dissection under general anesthesia were enrolled and randomized to receive erector spinae block with dexmedetomidine added to ropivacaine (intervention) or without dexmedetomidine (control). The primary outcome was total opioid consumption in the post-anesthesia care unit (PACU) and up to 24 hours postoperatively. Secondary outcomes included intraoperative hemodynamics, vitals, medications, and complications, as well as pain medications and levels, and side effects during the first 24 hours postoperatively. Results: PACU opioid consumption was significantly lower in patients who received the intervention compared to those who underwent the routine procedural protocol (3.14 ± 2.85 vs 5.86 ± 4.52, P = 0.021). Median survival time to opioid provision in the PACU and total morphine consumption up to 24 hours were not statistically significantly different between the two groups. Pain levels remained statistically significantly lower in the experimental group up to 12 hours postoperatively, after which no significant difference was observed. No significant side effects were reported. Conclusions: Dexmedetomidine, in safe doses, with ropivacaine in erector spinae block reduces immediate opioid consumption and postoperative pain in mastectomy patients.
Barakat et al. (Wed,) studied this question.