Effects of Adding Dexamethasone Plus Ketamine to Bupivacaine for Ultrasound-guided Serratus Plane Block as Analgesia in Major Breast Surgery: A Randomized, Double-blind Trial

Ahmed Hussein Bakeer; Ahmed Fakher Abdou; Jehan Mohamed Abdelhaleem; Doaa Abdeltawab Abdou

doi:10.3889/oamjms.2024.11825

Authors

Ahmed Hussein Bakeer Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Egypt https://orcid.org/0009-0004-0560-357X
Ahmed Fakher Abdou Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Egypt https://orcid.org/0009-0007-5880-5142
Jehan Mohamed Abdelhaleem Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Egypt
Doaa Abdeltawab Abdou Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Egypt

DOI:

https://doi.org/10.3889/oamjms.2024.11825

Keywords:

Dexamethasone, Ketamine, Bupivacaine, Serratus Plane Block, Modified radical mastectomy

Abstract

BACKGROUND: Post-operative pain after mastectomy is associated with poor recovery, prolonged hospital stays, and increased liability for chronic persistent pain.

AIM: This work aimed to test the analgesic efficacy of adding ketamine to a dexamethasone bupivacaine combination in ultrasound-guided serratus anterior plane block (SAPB) in patients undergoing modified radical mastectomy (MRM).

METHODS: This randomized, double-blind trial included 60 females aged 20–60 undergoing MRM. They were randomized into two groups: Group DB (n = 30) received SAPB using 30 ml of bupivacaine 0.25% and dexamethasone 4 mg. Group KD (n = 30) received the same block with the addition of ketamine 50 mg.

RESULTS: The time to the first analgesic request was significantly delayed in Group KD than in Group DB (p < 0.001). The number of patients requiring morphine and its total consumption during the first 24 post-operative hours in Group KD were significantly less than in Group DB (p = 0.001 and p < 0.001, respectively). Visual Analog Scale scores at rest and movement at 4, 6, 8, 10, 12, and 18 h were significantly lower in Group KD than in Group DB.

CONCLUSIONS: Adding ketamine to bupivacaine plus dexamethasone in ultrasound-guided SAPB is associated with better analgesic outcomes in patients undergoing MRM, including prolonged duration of analgesia and decreased post-operative morphine consumption and pain scores at rest and movement.

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