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 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




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


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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Bakeer AH, Abdou AF, Abdelhaleem JM, Abdou DA. 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. Open Access Maced J Med Sci [Internet]. 2024 Mar. 20 [cited 2024 Apr. 21];12:1-8. Available from: https://oamjms.eu/index.php/mjms/article/view/11825