Dexmedetomidine vs dexamethasone as adjuvants to levobupivacaine in ultrasound-guided erector spinae plane block for patients undergoing modified radical mastectomy: a randomized double-blind study

Background & Objective: Erector Spinae Plane block (ESPB) is used in patients subjected to modified radical mastectomy (MRM) as a part of balanced anesthesia technique, and to offer prolonged postoperative analgesia. Local anesthetic agents are usually combined with various adjuvants to augment the effect. We compared dexmedetomidine (Dex) versus dexamethasone as adjuvants to ESPB in patients undergoing MRM. Methodology: This randomized controlled study involved 90 patients subjected to MRM under general anesthesia with preoperative ESPB using 30 ml levobupivacaine 0.25%. They were randomly assigned into three equal groups according to the adjuvants used. Dex Group (n = 30) received 1 µg/kg dexmedetomidine, Dexa Group (n = 30) received 10 mg dexamethasone, and ESPB Group (n = 30) received no adjuvants. Patients were monitored for pain using VAS scores and vital signs. The primary outcome measure was total morphine consumption. The secondary outcomes were intraoperative fentanyl consumption, pain intensity, and analgesia duration. Results: The postoperative analgesia duration was significantly longer in the Dex group compared with the ESPB group (P = 0.029) but not in the dexamethasone group. Intraoperative fentanyl and postoperative morphine consumption were significantly lower in the Dex group than in the ESPB group. VAS scores were significantly lower in the Dex group than in the ESPB group at rest and movement. VAS scores of the Dexamethasone group were similar to that of the ESPB group at rest and movement. Conclusion: As an adjuvant to levobupivacaine in erector spinae plane block, dexmedetomidine reduces pain at rest and with movement, reduces intraoperative fentanyl and postoperative morphine consumption, and prolongs the analgesia duration. It is superior to dexamethasone in pain reduction and duration of analgesia. Key words: Analgesia; Dexamethasone; Dexmedetomidine; Erector Spinae Plane Block; Radical Mastectomy; Postoperative Pain Citation: Ahmed HI, Ali AR, El Emam NH, Magdy M, Gamal RM. Dexmedetomidine vs dexamethasone as adjuvants to levobupivacaine in ultrasound-guided erector spinae plane block for patients undergoing modified radical mastectomy: a randomized double-blind study. Anaesth. pain intensive care 2022;27(1):65−72. DOI: 10.35975/apic.v27i1.2122 Received: Oct 08, 2022; Reviewed: Nov 10, 2022; Accepted: Nov 22, 2022