الفهرس 
INTRODUCTION AND RATIONAOnly 14 pages are availabe for public view
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Abstract
Breast cancer is the most frequent malignant tumor in women worldwide. Oncologic breast surgeries were typically performed by using inhaled anesthesia followed by inpatient hospitalization. However, GA cannot provide postoperative incisional pain control. Thoracic paravertebral blocks are considered the ‘‘gold standard’’ regional anesthesia technique for patients undergoing breast surgery. Using ultrasound to visualize anatomical landmarks, it may be possible to improve the safety of the PVB. Dexmedetomidine is under evaluation as a neuraxial and peripheral nerve block adjuvant as it provides stable hemodynamic conditions, good quality of intraoperative and prolonged postoperative analgesia with minimal side effects.
After approval of our ethics committee a total of 72 ASA physical status I, ІІ and III patients undergoing breast surgery (modified radical mastectomy, simple mastectomy, lumpectomy) at Suez Canal University Hospital were enrolled in this prospective randomized comparative study with a predetermined aim to improve care and satisfaction of post-operative analgesia in patients undergoing breast surgery by adding dexmedetomidine to bupivacaine compared with bupivacaine alone in ultrasound guided paravertebral block in breast surgery.
Patients with history of hypersensitivity to local anesthetic (bupivacaine), relative or absolute contraindications for paravertebral were excluded from the study.
All of the studied patients were assessed through a preoperative visit and were instructed preoperatively about visual analogue scale (VAS) of pain score and a written informed consent was taken from every patient. Patients were assessed for ASA status, any medical disorder and past history of operations, anesthesia or hospitalization. Complete physical examination was done for all patients with stressing on anesthetic assessment as airway assessment. Routine preoperative investigations (CBC, bleeding profile, creatinine, liver enzymes, ECG and chest X-ray) were done for all patients. Patients were premedicated by oral diazepam 5 mg the night before surgery.
Patients were randomly allocated to one of two study groups: group B with using bupivacaine alone, and group BD with using dexmedetomidine added to bupivacaine in USG-TPVB. Two groups were compared for intraoperative analgesic requirements, post-operative analgesic consumption, time to first analgesic request, and post-operative pain at rest and at movement of ipsilateral arm.
First analgesic requirement was recorded and patients were given PCA IV morphine as rescue analgesia. Intraoperative and post-operative complications as hemodynamics instability, hypoxia, and pneumothorax were recorded.
There was no statistically significant difference between the two study groups regarding baseline characteristics.
Regarding intraoperative analgesic requirements and intraoperative and post-operative complications there were no statistically differences between both groups.
Regarding post-operative analgesic consumption, time to first analgesic request pain assessment via visual analogue scale during both rest and movement, our results showed that these parameters were significantly low in group BD compared to group B (p<0.5).