Quality of recovery after breast surgery: A randomized clinical trial comparing dexamethasone with dexmedetomidine as adjuvant to ropivacaine in ultrasound guided single shot mid- point transverse process to pleura block

Background

Mid-point transverse to pleura block (MTPB) is a recently introduced block used to alleviate postoperative pain in patients undergoing thoracic surgeries. The present study aims to compare the quality of recovery at 24 h post-operatively after adding dexamethasone and dexmedetomidine as adjuvants to 0.75 % ropivacaine in a single shot mid-point transverse process to pleura block (MTPB) in patients undergoing modified radical mastectomy (MRM) for carcinoma breast.

Design

Single center, assessor blinded, randomized clinical trial

Methods

Sixty ASA PS 1–2 females posted for MRM were randomized into 2 groups to receive either dexamethasone 8 mg or dexmedetomidine 1mcg/kg as adjuvant to 0.75 % ropivacaine in MTPB. The primary objective was to determine the quality of recovery using the Quality of Recovery (QoR-15) questionnaire at 24 h postoperatively. The secondary objectives were to determine the duration of analgesia, NRS scores for pain at rest and on movement in the post-operative period, total accumulative requirement of analgesics, patient satisfaction with block and future willingness to undergo repeat peripheral nerve block.

Results

The QoR‐15 score was 128.20 ± 6.93 and 128.37 ± 4.06 in the dexamethasone and dexmedetomidine groups respectively. Duration of analgesia was 10.85 ± 5.31 h and 20.20 ± 11.26 h in the dexamethasone and dexmedetomidine groups, respectively (P < 0.01). Pain severity was significantly higher at all timepoints during rest and at 1 h, 4 h, 8 h, and 12 h time points during movement in the dexamethasone group. Intraoperatively, SBP and HR were lower in the dexmedetomidine group at 5 min, at incision, 10 min, 15 min, 20 min, 25 min, and 30 min. DBP was lower in the dexmedetomidine group at 5 min, at incision, 15 min, and 20 min (P < 0.01). Postoperatively BP was comparable among the groups, but HR remained lower in the dexmedetomidine group, coinciding with lower NRS scores at the same time points (P < 0.01). Lower PCM consumption was observed in 24 h in the dexmedetomidine group (P < 0.01). The patient satisfaction score was comparable among the groups.

Conclusions

Preoperative single- shot ultrasound guided mid-point transverse to pleura block with ropivacaine using dexmedetomidine and dexamethasone resulted in a good patient-reported quality of recovery.