الفهرس 
Content
Technique of epidural anaesthesiaOnly 14 pages are availabe for public view
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Abstract
Breast cancer is the most common cancer diagnosed in Egyptian women the incidence is increasing worldwide at an alarming rate and is a leading cause of mortality in women.
MRM is the standard surgical procedure of choice in these patients. It is usually performed under general anesthesia, almost always combining intravenous and inhalational agents. One of the drawbacks of general anesthesia is inadequate pain control which may lead to undesirable effects and patient dissatisfaction.
We considered TEA which faces growing interest as adjuvant anesthetic and peri-operative analgesic regimen. With the use of adjuvants which have a powerful analgesic effect as ketamine and dexmedetomedine in a small doses with local anesthetic to prolong the duration of action, give better success rate and to increase the patient satisfaction.
The study was carried out in surgical oncology department and postoperative intensive care unit in South Egypt Cancer Institute (SECI), Assuit University, Egypt in the period between September 2016 and June 2017.
Ninety six Patients were assessed for enrollment in this study, among them 16 were excluded as 9 patients did not meet the inclusion criteria and the other 7 declined to participate. Eighty patients were actually allocated in this study and were randomly assigned into one of four groups of 20 patients each, by using opaque sealed envelopes containing computer generated randomization schedule. The opaque sealed envelopes were sequentially numbered, and were opened before application of anesthetic plan. The investigated drugs were prepared in a sterile syringe by hospital pharmacy and given to the investigator who was blind to the identity of the drugs.
The day before surgery, Patients were subjected to careful medical and surgical history taking. Physical examination and routine laboratory investigations were. Surgery was performed under standard general anesthesia plus preoperative insertion of thoracic epidural catheter at T4- 5 interspace under strict aseptic precautions.
Patients were classified into four groups (DK) group received bupivacaine plus mixture of both ketamine and dexmedetomedine, (K) group received bupivacaine plus ketamine,(D) group received bupivacaine plus dexmedetomedine while the (C) received bupivacaine only.
MAP, HR and SO2 were measured and recorded preoperatively and at times 5, 30 and 60 minutes intra operative.
After full recovery all patients were admitted to surgical ICU-for 48 hours for monitoring of vital signs, postoperative pain, the first request for rescue analgesia, total morphine consumption, side effects and sedation score.
Conclusion:
According to our results; The TEA is an effective and safe adjunct to multimodal post-operative analgesia for breast cancer surgeries. Multiple studies have demonstrated its superiority over standard medical therapy for postoperative pain control. TEA may be a good alternative strategy for patients who are highly sensitive to opioids as it provides comparable analgesia as well as patient satisfaction to opioid therapy.