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SECI Oncology Journal /
 SECI Oncology Journal /
  تفاصيل البحث
 
[9002059.] رقم البحث : 9002059 -
Effect of adding dexmedetomedine, ketamine and their combination to bupivacaine in thoracic epidural on post-operative analgesia in patients undergoing modified radical mastectomy. /
تخصص البحث : General
  SECI Oncology Journal / / vol.6 - 2018
  ندي طلعت فرغلي محمد
  ابتسام محمد عبد الرازق - مؤلف رئيسي
  TEA, dexmedetomedine, ketamine, Breast cancer surgery.
  Background:
Breast cancer is the most frequent tumor in women. The incidence of breast cancer, as well as the need of surgical treatment has increased probably due to increased awareness and improved diagnostic tools resulting in early diagnosis and favorable surgical outcome [1].
Conventionally general anesthesia is the most frequently used technique, but it is associated with inadequate pain control due to lack of residual analgesia and also with other
Abstract:
Background: Breast surgery is one of the most common forms of surgery conducted in hospitals; even relatively minor breast surgery can be associated with significant postoperative pain. Opioid administration remains the mainstay of postoperative pain relief, but it can result in significant adverse effects including sedation, nausea, vomiting urinary retention, respiratory depression, delayed recovery of colonic mobility, and prolonged postoperative ileus.
Objective: To investigate the efficacy and safety of adding dexmedetomedine, ketamine and their combination as adjuvant analgesic with bupivacaine in thoracic epidural analgesia (TEA) on post mastectomy pain, detection of total dose of IV morphine consumption and time for the first request of rescue analgesia.
Design: Prospective, randomized, double-blinded clinical trial.
Setting: Academic medical center.
Methods: Eighty patients were randomly allocated to receive at T4-5 interspace thoracic epidural analgesia 15 minutes -before general anesthesia (GA)- either 12 ml of hyperbaric bupivacaine 0.125% plus mixture of 0.3 mg/kg ketamine and 0.1?g/kg dexmedetomedine (DK group) & 12 ml of hyperbaric bupivacaine 0.125% plus 0.5 mg/kg ketamine (K group) &12 ml of hyperbaric bupivacaine 0.125% plus 1?g/kg dexmedetomedine (D group) while the control group received 12 ml of hyperbaric bupivacaine 0.125% (C group). Post-operative patients were admitted to surgical ICU-for 48 hours for initiation of post-operative analgesia regimen and monitoring of hemodynamics, pain score, time to first request of analgesia, total patient controlled analgesia (PCA) morphine consumption and adverse effects.
Results: Time to first request of analgesia was the longest in DK group as no one asked for analgesia during the first 48 hours, while it was longer in K group (37.45±3.12 h) compared to D group (19.43±1.78) and the control group (13.47±1.43h).
-PCA morphine consumption was less in K group (4.66±1.00 mg) compared to D group (6.74±0.70 mg) and control group (8.33±1.63mg), while DK group did not receive PCA morphine.DK group showed lower postoperative pain scores.
Conclusion: the combination of both dexmedetomedine and ketamine added to bupivacaine in TEA in patients undergoing MRM provided superior postoperative analgesia, prolonged the time to first request of analgesia, and reduced the total consumption of PCA morphine, without serious side effects compared to either drug alone.
Clinical trial registration: NCT03063671
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