Comparative analgesic efficacy of ketamine versus neostigmine as adjuvants to bupivacaine during ultrasound-guided serratus anterior plane block in modified radical mastectomy
Abstract
Background & objective: Peripheral nerve blocks are efficient options for pain management in breast operations. Following modified radical mastectomy, the application of serratus anterior plane block has been shown to be very successful at controlling pain and minimizing narcotic usage. To increase the peripheral nerve block's duration and strength, numerous adjuvants to local anesthetics have been employed. We compared the effectiveness of neostigmine with ketamine as analgesic adjuvants to local anesthetic in US-guided serratus anterior plane block in patients undergoing modified radical mastectomy.
Methodology: A randomized, prospective, double-blinded comparative study, performed at Ain-Shams University Hospitals on 75 adult females aged 30-65 y, who were planned for a modified radical mastectomy and received serratus anterior plane block immediately after the procedure. Patients were randomly divided into 3 groups, 25 patients per group. Group BK: received 1 ml (50 mg) ketamine added to 20 ml of bupivacaine 0.25%. Group BN: received 1 ml (0.5 mg) neostigmine added to 20 ml of bupivacaine 0.25% and Group BS: received 1 ml normal saline added to 20 ml of bupivacaine 0.25%. The primary outcome was the total amount of nalbuphine consumed in a 24-h period. The secondary outcomes were the patient's hemodynamics, pain scores, and time to first rescue analgesia request.
Results: Total 24 h nalbuphine consumption was statistically significantly varying between the study groups (P < 0.001); the highest consumption of nalbuphine was in Group BS. As regards numeric pain scale at 2 h and 6 h postoperative there was significant statistical difference among Group BS with each of Group BK and Group BN (P = 0.001, P < 0.001 respectively). At 12 h and 24 h postoperative the difference was significant between all study groups. As regards requesting rescue analgesia there was significant variance among Group BS and each of Group1 and Group BN with no significant variance among Group BK and Group BN.
Conclusion: In serratus anterior plane block, adding 50 mg ketamine to bupivacaine decrease 24 h nalbuphine consumption and numeric pain scale, adding 0.5 mg neostigmine to bupivacaine has lower rate of requesting rescue analgesia following ketamine.
Trial Registry: NCT05802979.
Keywords: serratus anterior, ketamine, neostigmine, ultrasound, analgesia, modified radical mastectomy.
Citation: Saleh M, Saeed M, Rafat E, Hisham A. Comparative analgesic efficacy of ketamine versus neostigmine as adjuvants to bupivacaine during ultrasound-guided serratus anterior plane block in modified radical mastectomy. Anaesth. pain intensive care 2024;28(2):315−323; DOI: 10.35975/apic.v28i2.2440
Received: December 18, 2023; Revised: February 08, 2024; Accepted: (February 13, 2024
