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

Abstract

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.

Full Text

This preprint is available for download as a PDF.

Tables

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.