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