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Year : 2017  |  Volume : 4  |  Issue : 2  |  Page : 59-64

Comparison between dexmedetomidine versus morphine added to bupivacaine in paravertebral block in patients scheduled for modified radical mastectomy

Department of Anaethesia and Surgical Intensive Care, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Correspondence Address:
Mohamed Metwally
7 El-Mashtal, 2nd Street, Abu Yusef Al_Agamy, Alexandria
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/roaic.roaic_10_16

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Purpose The aim of the paper was to compare between dexmedetomidine (DM) versus morphine added to bupivacaine in paravertebral block (PVB) for perioperative analgesia in modified radical mastectomy in relation to hemodynamic stability, efficacy of pain relief, and possible complications. Patients and methods A randomized, double-blind, controlled trial was conducted on 45 American Society of Anesthesiologists I–II patients undergoing elective unilateral modified radical mastectomy. Patients were randomly allocated into three groups: group B (n=15) received 20 ml of 0.25% bupivacaine (as control group), group D (n=15) received 20 ml of 0.25% bupivacaine+100 μg DM, and group M (n=15) received 20 ml of 0.25% bupivacaine+2 mg morphine. Hemodynamic parameters, area of local anesthesia, postoperative oxygen saturation and respiratory rate, visual analog scale (VAS) score, shoulder restriction score, time to first dose, and total amounts of supplementary analgesia (meperidine hydrochloride) were recorded. Postoperative sedation was evaluated using Ramsay sedation scale, and postoperative nausea and vomiting were evaluated using postoperative nausea and vomiting impact scale score. Other side effects were also recorded. Results There were no significant differences between the three studied groups at baseline regarding heart rate, mean arterial blood pressure, arterial oxygen saturation (SpO2), and respiratory rate. There was a significant reduction in heart rate in group D since the initiation of skin incision till the end of operation. There was a significant reduction in mean arterial blood pressure in the three groups from the starting of skin incision till the end of operation, but it was more evidenced in group D. Arterial oxygen saturation (SpO2) and respiratory rate were comparable between the three groups at all measuring times. There was significantly lower postoperative VAS score, longer time to first dose, and lower consumption of meperidine hydrochloride in group D than group B and group M. The present study did not show any serious intraoperative or postoperative complications in the three studied groups. Conclusion The addition of DM to bupivacaine in PVB provides a significant clinical benefit by decreasing VAS score, decreasing postoperative use of analgesics, and prolonging the onset of postoperative analgesic requirement without serious adverse effects and is superior to morphine as an adjuvant in PVB.

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