Acute Pain Clinical Trial
Official title:
Effect of Adding Dexmedetomidine, Ketamine and Their Combination to Bupivicaine in Thoracic Epidural Analgesia on Post-mastectomy Pain
This study investigate the effect of addition dexmedetomidine, ketamine or their combination to bupivacaine in thoracic epidural analgesia on acute postoperative pain after breast cancer surgery.
Breast cancer is the most common cancer diagnosed in Egyptian women. Many modalities are used
in the treatment of breast cancer including chemotherapy, radiotherapy or surgical
intervention. Nowadays, surgical intervention is more conservative.Modified radical
mastectomy (MRM) is the standard surgical procedure of choice in these patients. MRM is
usually performed under general anesthesia, almost always combining intravenous and
inhalational agents.The drawback of general anesthesia includes inadequate pain control due
to lack of analgesia, high incidence of nausea and vomiting, stress of anesthesia and
surgery, and increasing the length of hospital stay.Post mastectomy pain is a pain which
occur following breast cancer procedures, particularly those operations that remove tissues
in upper outer quadrant of breast and/or axilla. This pain can be severe enough to cause long
term disabilities and interfere with sleep, performance of daily activities. Also, it can
seriously affect the patient mood, and social functions.
Thoracic epidural analgesia (TEA) faces growing interest as adjuvant anesthetic and
post-operative analgesic regimen. the use of adjuvant drug with local anesthetic is essential
as it prolongs the duration of action, gives better success rate and increases patient
satisfaction.
Ketamine, an N-methyl-D-aspartate (NMDA) antagonist, not only abolishes peripheral afferent
noxious stimulation, but it can also prevent the central sensitization of nociceptors. When
added to epidural local anesthetics, ketamine appears to have adjuvant effects.
Dexmedetomedine is a selective, α2-adrenoceptor agonist with analgesic potency, sedative
properties, and minimal respiratory depression when used as an adjuvant to regional
anesthesia.
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