Efficacy and safety of ultrasound-guided serratus anterior plane block with different doses of dexmedetomidine for patients undergoing modified radical mastectomy: A randomized controlled trial

doi:10.21203/rs.3.rs-470606/v1

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Efficacy and safety of ultrasound-guided serratus anterior plane block with different doses of dexmedetomidine for patients undergoing modified radical mastectomy: A randomized controlled trial

https://doi.org/10.21203/rs.3.rs-470606/v1

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Background: Ultrasound-guided serratus anterior plane block (USG-SAPB) has been used for pain management of patients undergoing modified radical mastectomy (MRM), but evidence supporting the adjuvant analgesic benefits is limited. We explored the efficacy and safety of preemptive use of different concentrations of dexmedetomidine and ropivacaine in USG-SAPB for patients undergoing MRM.

Patients and methods: Ninety-five female patients were randomly allocated to RD1 and RD2 groups. USG-SAPB was performed before anesthesia induction. Consumption of sufentanil, postoperative pain scores, and level of sedation were recorded 1–72 h postoperatively. Intraoperative hemodynamics, PACU length of stay, incidence of moderate-severe pain, one-time puncture success, block procedure time, time to first rescue analgesia, satisfaction scores of patients and surgeons, hospital length of stay, adverse events, the prevalence of chronic pain, and quality of postoperative functional recovery were recorded.

Results: Dynamic VAS was significantly lower at 4, 8, and 12 h after surgery and sufentanil need was significantly lower at 4, 8, 12, 24, and 48 h after surgery in the RD2 group (P<0.05). The incidence of moderate-severe pain was significantly lower in the RD2 group (P<0.05). Time to first rescue analgesia was significantly longer in the RD2 group (P=0.047). Consumption of propofol, remifentanil, dexmedetomidine, use of vasoactive agents, and PACU length of stay (LOS) were significantly reduced in RD2 patients (P<0.05). There were no significant diﬀerences between the two groups with respect to procedural variables or satisfaction scores of patients and surgeons, and/or postoperative complications. The hospital LOS, global QoR-40, and prevalence of chronic pain were comparable.

Conclusions: Use of 1 μg/kg dexmedetomidine and ropivacaine in USG-SAPB can provide superior postoperative analgesia for patients undergoing MRM without additional adverse effects, and result in similar quality of postoperative functional recovery and prevalence of chronic pain.

Anesthesiology & Pain Medicine

dexmedetomidine

modified radical mastectomy

pain management

ropivacaine

serratus anterior plane block

ultrasound

Table 1 Comparison of demographic data between the two groups

	Group RD1 (n=47)	Group RD2 (n=48)		P-values
Age (years)	52.56±5.83		51.82±6.91	0.572
Body weight (kg)	65.21±6.08		63.89±8.36	0.378
BMI (kg·m^–2)	22.74±3.01		23.15±3.67	0.551
ASA Ⅰ/Ⅱ (n)	24/23		30/18	0.261
Comorbidity, n (%) Hypertension Diabetes mellitus Coronary heart disease COPD/asthma	12 (22.53%) 8 (17.02%) 5 (10.64%) 1 (2.13%）		10 (20.83%) 7 (14.58%) 6 (12.50%） 1 (2.08%）	0.965

Variables presented as mean ± SD or number of patients n (%).BMI=body mass index; ASA=American Society of Anesthesiology; COPD=chronic obstructive pulmonary disease.

Table 2 Intraoperative data between the two groups

	Group RD1 (n=47)	Group RD2 (n=48)		P-values
Location (left/right), n	30/17		25/23	0.301
Duration of anaesthesia (min)	108.83±18.03		115.98±19.38	0.063
Duration of surgery (min)	97.93±10.56		102.36±15.84	0.108
Fluids (ml)	758.82±59.93		808.29±69.08	0.083
Dexmedetomidine (μg·kg^–1·h^–1)	0.32±0.06		0.23±0.04**	0.001
Remifentanil (μg·kg^–1·min^–1)	0.16±0.05		0.10±0.04**	0.001
Propofol (μg·ml^–1)	4.76±1.04		3.52±0.65*	0.037
Cisatracurium dosage (mg·kg^–1)	0.13±0.05		0.14±0.05	0.332
One-time puncture success, n (%)	45 (95.74%)		46 (95.83%)	1.000
Block procedure time (min)	5.34±0.98		4.89±0.83	0.268
Number of using vasoactive agent, n (%)	12 (25.54%)		7 (14.58%)*	0.045
PACU length of stay (min)	23.71±6.92		18.93±4.28*	0.018

Variables presented as mean ± SD or number of patients n (%). PACU=post-anesthesia care unit. *P < 0.05 vs. Group RD1; ** P < 0.01 vs. Group RD2.

Table 3 Dermatomal effects after SABP between the two groups

	Group RD1 (n=47)	Group RD2 (n=48)	P-values
T1	3	10*	0.040
T2	14	25*	0.027
T3	45	46	1.000
T4	47	48	1.000
T5	43	46	0.435
T6	23	28	0.306
T7	12	17	0.296
T8	4	7	0.355

Variables presented as number of patients. *P < 0.05 vs. Group RD1.

Table 4 Postoperative level of sedation, rescue analgesia, patients and surgeons satisfaction between the two groups

	Group RD1 (n=47)	Group RD2 (n=48)	P-values
LOS 1 h 2 h 4 h 8 h 12 h 24 h 48 h 72 h	1 (1-2) 1 (0-2) 1 (0-2) 0 (0-2) 0 (0-2) 0 (0-1) 0 (0-0) 0 (0-0)	1 (0-2) 1 (0-2) 1 (0-2) 0 (0-2) 0 (0-2) 0 (0-1) 0 (0-0) 0 (0-0)	0.727
Patients satisfaction score	4.25 (3.75-5.00)	4.25 (3.75-4.75)	0.093
Surgeons satisfaction score	4.50 (4.25-5.00)	4.50 (4.00-5.00)	0.142

Variables presented as number of patients n (%) or median (interquartile range). LOS= level of sedation..

Table 5 Comparison of incidence of adverse effects, hospital length of stay, QoR-40 and prevalence of chronic pain between the two groups

	Group RD1 (n=47)	Group RD2 (n=48)	P-values
Adverse effects
PONV	10 (21.28%)	6 (16.67%)	0.253
Urinary retention	5 (10.64%)	5 (10.42%)	0.972
Itching	4 (8.51%)	3 (6.25%)	0.714
Cardiovascular complications Respiratory complications Block related complications	0 0 0	0 0 0	1.000 1.000 1.000
Hospital length of stay	6 (4-8)	5 (5-7)	0.302
Prevalence of chronic pain, n (%)	15 (31.91%)	13 (27.08%)	0.606
Global QoR-40
Pre-operative	185 (178-197)	186 (174-195)	0.521
Postoperative day 1 On discharge 3 month later	167 (153-186) 177 (174-188) 182 (166-192)	172 (158-188) 179 (174-186) 184 (164-195)	0.096 0.277 0.193

Variables presented as number of patients n (%) or median (interquartile range). PONV= postoperative nausea and vomiting; QoR-40=40-item Quality of Recovery questionnaire.

No competing interests reported.

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Efficacy and safety of ultrasound-guided serratus anterior plane block with different doses of dexmedetomidine for patients undergoing modified radical mastectomy: A randomized controlled trial

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