Background: The most common surgical procedure for breast cancer is the modified radical mastectomy (MRM), but it is associated with significant postoperative pain. Regional anesthesia can reduce the stress response associated with surgical trauma. Objectives: Our aim is to explore the efficacy of 1 μg/kg dexmedetomedine added to an ultrasound (US)-modified pectoral (Pecs) block on postoperative pain and stress response in patients undergoing MRM. Study Design: A randomized, double-blind, prospective study. Setting: An academic medical center. Methods: Sixty patients with American Society of Anesthesiologists (ASA) physical status I– II (18–60 years old and weighing 50–90 kg) scheduled for MRM were enrolled and randomly assigned into 2 groups (30 in each) to receive a preoperative US Pecs block with 30 mL of 0.25% bupivacaine only (group 1, bupivacaine group [GB]) or 30 mL of 0.25% bupivacaine plus 1 μg/ kg dexmedetomidine (group II, dexmedetomidine group [GD]). The patients were followed-up 48 hours postoperatively for vital signs (heart rate [HR], noninvasive blood pressure [NIBP], respiratory rate [RR], and oxygen saturation [Sao2]), visual analog scale (VAS) scores, time to first request of rescue analgesia, total morphine consumption, and side effects. Serum levels of cortisol and prolactin were assessed at baseline and at 1 and 24 hours postoperatively. Results: A significant reduction in the intraoperative HR, systolic blood pressure (SBP), and diastolic blood pressure (DBP) starting at 30 minutes until 120 minutes in the GD group compared to the GB group (P 0.05) was observed. The VAS scores showed a statistically significant reduction in the GD group compared to the GB group, which started immediately up until 12 hours postoperatively (P 0.05). There was a delayed time to first request of analgesia in the GD group (25.4 ± 16.4 hrs) compared to the GB group (17 ± 12 hrs) (P = 0.029), and there was a significant decrease of the total amount of morphine consumption in the GD group (9 + 3.6 mg) compared to the GB group (12 + 3.6 mg) (P = 0.001). There was a significant reduction in the mean serum cortisol and prolactin levels at 1 and 24 hours postoperative in the GD patients compared to the GB patients (P 0.05). Limitations: This study was limited by its sample size. Conclusion: The addition of 1 μg/kg dexmedetomidine to an US-modified Pecs block has superior analgesia and more attenuation to stress hormone levels without serious side effects, compared to a regular Pecs block in patients who underwent MRM.

Background: The most common surgical procedure for breast cancer is the modified radical mastectomy (MRM), but it is associated with significant postoperative pain. Regional anesthesia can reduce the stress response associated with surgical trauma. Objectives: Our aim is to explore the efficacy of 1 μg/kg dexmedetomedine added to an ultrasound (US)-modified pectoral (Pecs) block on postoperative pain and stress response in patients undergoing MRM. Study Design: A randomized, double-blind, prospective study. Setting: An academic medical center. Methods: Sixty patients with American Society of Anesthesiologists (ASA) physical status I– II (18–60 years old and weighing 50–90 kg) scheduled for MRM were enrolled and randomly assigned into 2 groups (30 in each) to receive a preoperative US Pecs block with 30 mL of 0.25% bupivacaine only (group 1, bupivacaine group [GB]) or 30 mL of 0.25% bupivacaine plus 1 μg/ kg dexmedetomidine (group II, dexmedetomidine group [GD]). The patients were followed-up 48 hours postoperatively for vital signs (heart rate [HR], noninvasive blood pressure [NIBP], respiratory rate [RR], and oxygen saturation [Sao2]), visual analog scale (VAS) scores, time to first request of rescue analgesia, total morphine consumption, and side effects. Serum levels of cortisol and prolactin were assessed at baseline and at 1 and 24 hours postoperatively. Results: A significant reduction in the intraoperative HR, systolic blood pressure (SBP), and diastolic blood pressure (DBP) starting at 30 minutes until 120 minutes in the GD group compared to the GB group (P 0.05) was observed. The VAS scores showed a statistically significant reduction in the GD group compared to the GB group, which started immediately up until 12 hours postoperatively (P 0.05). There was a delayed time to first request of analgesia in the GD group (25.4 ± 16.4 hrs) compared to the GB group (17 ± 12 hrs) (P = 0.029), and there was a significant decrease of the total amount of morphine consumption in the GD group (9 + 3.6 mg) compared to the GB group (12 + 3.6 mg) (P = 0.001). There was a significant reduction in the mean serum cortisol and prolactin levels at 1 and 24 hours postoperative in the GD patients compared to the GB patients (P 0.05). Limitations: This study was limited by its sample size. Conclusion: The addition of 1 μg/kg dexmedetomidine to an US-modified Pecs block has superior analgesia and more attenuation to stress hormone levels without serious side effects, compared to a regular Pecs block in patients who underwent MRM.

Objective. Effective postoperative pain control reduces postoperative morbidity. In this study, we investigated the effects of intrathecal morphine, ketamine, and their combination with bupivacaine for postoperative analgesia in major abdominal cancer surgery. Study Design. Prospective, randomized, doubleblind. Setting. Academic medical center. Patients and Methods. Ninety ASA I–III patients age 30 to 50 years were divided randomly into three groups: the morphine group (group M) received 10mg of hyperbaric bupivacaine 0.5% in 2mL volume and 0.3mg morphine in 1mL volume intrathecally. The ketamine group (group K) received 0.1 mg/kg ketamine in 1mL volume instead of morphine. The morphine1ketamine group (group K1M) received both 0.3mg morphine and 0.1mg/kg ketamine in 1mL volume intrathecally. Postoperative total morphine consumption, first request of analgesia, visual analog score (VAS), and side effects were recorded. Results. Total PCA morphine was significantly decreased in group M1K compared with groups M and K. Time to first request of analgesia was prolonged in groups M and M1K compared with group K (P 0.001). VAS in group M1K was reduced from two to 24 hours, and in group M from 12 and 18 hours postoperation compared with group K, with an overall good analgesia in the three groups. Sedation was significantly higher in group M1K compared with group M until six hours postoperation. No other side effects were observed. Conclusions. Adding intrathecal ketamine 0.1mg/kg to morphine 0.3mg in patients who underwent major abdominal cancer surgery reduced the total postoperative morphine consumption in comparison with either drug alone, with an overall good postoperative analgesia in all groups, with no side effects apart from sedation.

Objective. Effective postoperative pain control reduces postoperative morbidity. In this study, we investigated the effects of intrathecal morphine, ketamine, and their combination with bupivacaine for postoperative analgesia in major abdominal cancer surgery. Study Design. Prospective, randomized, doubleblind. Setting. Academic medical center. Patients and Methods. Ninety ASA I–III patients age 30 to 50 years were divided randomly into three groups: the morphine group (group M) received 10mg of hyperbaric bupivacaine 0.5% in 2mL volume and 0.3mg morphine in 1mL volume intrathecally. The ketamine group (group K) received 0.1 mg/kg ketamine in 1mL volume instead of morphine. The morphine1ketamine group (group K1M) received both 0.3mg morphine and 0.1mg/kg ketamine in 1mL volume intrathecally. Postoperative total morphine consumption, first request of analgesia, visual analog score (VAS), and side effects were recorded. Results. Total PCA morphine was significantly decreased in group M1K compared with groups M and K. Time to first request of analgesia was prolonged in groups M and M1K compared with group K (P 0.001). VAS in group M1K was reduced from two to 24 hours, and in group M from 12 and 18 hours postoperation compared with group K, with an overall good analgesia in the three groups. Sedation was significantly higher in group M1K compared with group M until six hours postoperation. No other side effects were observed. Conclusions. Adding intrathecal ketamine 0.1mg/kg to morphine 0.3mg in patients who underwent major abdominal cancer surgery reduced the total postoperative morphine consumption in comparison with either drug alone, with an overall good postoperative analgesia in all groups, with no side effects apart from sedation.

Objective. Effective postoperative pain control reduces postoperative morbidity. In this study, we investigated the effects of intrathecal morphine, ketamine, and their combination with bupivacaine for postoperative analgesia in major abdominal cancer surgery. Study Design. Prospective, randomized, doubleblind. Setting. Academic medical center. Patients and Methods. Ninety ASA I–III patients age 30 to 50 years were divided randomly into three groups: the morphine group (group M) received 10mg of hyperbaric bupivacaine 0.5% in 2mL volume and 0.3mg morphine in 1mL volume intrathecally. The ketamine group (group K) received 0.1 mg/kg ketamine in 1mL volume instead of morphine. The morphine1ketamine group (group K1M) received both 0.3mg morphine and 0.1mg/kg ketamine in 1mL volume intrathecally. Postoperative total morphine consumption, first request of analgesia, visual analog score (VAS), and side effects were recorded. Results. Total PCA morphine was significantly decreased in group M1K compared with groups M and K. Time to first request of analgesia was prolonged in groups M and M1K compared with group K (P 0.001). VAS in group M1K was reduced from two to 24 hours, and in group M from 12 and 18 hours postoperation compared with group K, with an overall good analgesia in the three groups. Sedation was significantly higher in group M1K compared with group M until six hours postoperation. No other side effects were observed. Conclusions. Adding intrathecal ketamine 0.1mg/kg to morphine 0.3mg in patients who underwent major abdominal cancer surgery reduced the total postoperative morphine consumption in comparison with either drug alone, with an overall good postoperative analgesia in all groups, with no side effects apart from sedation.

Objective. Effective postoperative pain control reduces postoperative morbidity. In this study, we investigated the effects of intrathecal morphine, ketamine, and their combination with bupivacaine for postoperative analgesia in major abdominal cancer surgery. Study Design. Prospective, randomized, doubleblind. Setting. Academic medical center. Patients and Methods. Ninety ASA I–III patients age 30 to 50 years were divided randomly into three groups: the morphine group (group M) received 10mg of hyperbaric bupivacaine 0.5% in 2mL volume and 0.3mg morphine in 1mL volume intrathecally. The ketamine group (group K) received 0.1 mg/kg ketamine in 1mL volume instead of morphine. The morphine1ketamine group (group K1M) received both 0.3mg morphine and 0.1mg/kg ketamine in 1mL volume intrathecally. Postoperative total morphine consumption, first request of analgesia, visual analog score (VAS), and side effects were recorded. Results. Total PCA morphine was significantly decreased in group M1K compared with groups M and K. Time to first request of analgesia was prolonged in groups M and M1K compared with group K (P 0.001). VAS in group M1K was reduced from two to 24 hours, and in group M from 12 and 18 hours postoperation compared with group K, with an overall good analgesia in the three groups. Sedation was significantly higher in group M1K compared with group M until six hours postoperation. No other side effects were observed. Conclusions. Adding intrathecal ketamine 0.1mg/kg to morphine 0.3mg in patients who underwent major abdominal cancer surgery reduced the total postoperative morphine consumption in comparison with either drug alone, with an overall good postoperative analgesia in all groups, with no side effects apart from sedation.

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