Mohta, M., Kalra, B., Sethi, A.K., & Kaur, N. (2016). Efficacy of dexmedetomidine as an adjuvant in paravertebral block in breast cancer surgery. Journal of Anesthesia, 30, 252–260.

DOI Link

Study Purpose

To evaluate the efficacy of dexmedetomidine in combination with bupivacaine for analgesia with paravertebral block

Intervention Characteristics/Basic Study Process

Women undergoing breast cancer surgery receiving a paravertebral block were randomized to receive only bupivacaine, the combination of bupivacaine and dexmetedomidine in the block, or a sham block. All had the same general anesthesia and received IV PCA with morphine for postoperative pain management. All were premedicated with oral diazepam two hours prior to surgery. Vital signs, pain scores, and sedation scores were recorded every 30 minutes for the first two hours, and then at 4, 8, and 24 hours after surgery. Morphine 1.5 mg was given every five minutes until pain level was 3 or less, when pain score was 3 or greater.

Sample Characteristics

  • N: 45   
  • AGE: Mean = 47.27 years
  • FEMALES: 100%
  • CURRENT TREATMENT:  Other
  • KEY DISEASE CHARACTERISTICS: Breast cancer undergoing unilateral breast surgery

Study Design

Double-blind, sham, controlled RCT

Measurement Instruments/Methods

  • Numeric pain rating scale
  • Richmond Agitation Sedation Score 
  • Time to first analgesic request: NRS of 3 or greater
  • Cumulative morphine consumption
  • Time to mobilization

Results

There were no significant differences across groups in duration of surgery or duration of anesthesia. Total morphine consumption was significantly lower in the group who received the combination of dexmetedomidine and bupivacaine compared to the other groups (p < 0.001). Pain intensity scores were significantly lower in this group compared to the others at all time points both at rest and on movement (p < 0.001).

Conclusions

Paravertebral block with the cominbation of dexedetomidine and bupivacaine was associated with better postoperative pain control in this group of patients.

Limitations

Small sample (< 100)

 

Nursing Implications

Use of dexmedetomidine as an adjunct to bupivacaine in paravertebral block was effective for reduction in postoperative pain and overall opioid consumption in this study. This study was limited by its small sample size. Additional research in this approach is warranted.