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Comparison of Postoperative Pain After Modified Radical Mastectomy Using Erector Spinae Plane Block with Bupivacaine Plus Dexmedetomidine versus Bupivacaine Alone

Ayesha Siddiqa1, Muzammil Hussain1
1Department of Anaesthesia, ICU and Pain Management, Sir Ganga Ram Hospital, Lahore, Pakistan
DOI: https://doi.org/10.70517/revcc2624169
Published: 15/10/2026
: Ayesha Siddiqa, Muzammil Hussain. Comparison of Postoperative Pain After Modified Radical Mastectomy Using Erector Spinae Plane Block with Bupivacaine Plus Dexmedetomidine versus Bupivacaine Alone. Revista Cultura Científica, 2026 Issue 24. pg. 2034-2043.

Abstract

Background: Modified radical mastectomy (MRM), particularly when accompanied by axillary dissection, can cause substantial acute postoperative pain and may contribute to persistent postsurgical pain. Ultrasound-guided erector spinae plane block (ESPB) is used as a component of multimodal analgesia, and dexmedetomidine has been investigated as an adjuvant to prolong local-anaesthetic effects. Objective: To compare postoperative pain scores and rescue-analgesia requirements after MRM in patients receiving ESPB with bupivacaine plus dexmedetomidine versus bupivacaine alone. Methods: This single-centre randomized controlled trial was conducted in the Department of Anaesthesiology, ICU and Pain Management, Sir Ganga Ram Hospital, Lahore, Pakistan, from March to June 2026. Sixty women with American Society of Anesthesiologists (ASA) physical status I–II who were scheduled for elective MRM under general anaesthesia were allocated by lottery to two equal groups (n=30 each). A unilateral ultrasound-guided ESPB was performed at the T4 level after surgery. Group BD received 20 mL of 0.25% bupivacaine with dexmedetomidine 1 μg/kg, whereas Group B received 20 mL of 0.25% bupivacaine without dexmedetomidine. Pain intensity was assessed using a 10-cm visual analogue scale (VAS) at 1, 12 and 24 hours postoperatively. Results: Mean VAS scores were lower in Group BD than in Group B at 1 hour (1.2 ± 0.4 vs. 2.1 ± 0.5), 12 hours (1.5 ± 0.6 vs. 2.8 ± 0.7) and 24 hours (1.8 ± 0.5 vs. 3.1 ± 0.8); all reported between-group pain comparisons had p < 0.001. Rescue analgesia was required by 6 of 30 (20.0%) patients in Group BD and 19 of 30 (63.3%) in Group B (two-sided Fisher’s exact p=0.0014, recalculated from the reported frequencies). No clinically significant haemodynamic instability or block-related complications were reported in either group during the observation period. Conclusion: Adding dexmedetomidine to bupivacaine for ESPB was associated with lower pain scores during the first 24 postoperative hours and fewer requests for rescue analgesia after MRM. Interpretation is limited by the modest, single-centre sample and short follow-up; the findings do not establish prevention of chronic postsurgical pain or demonstrate comparative safety for uncommon adverse events.

Keywords: erector spinae plane block, dexmedetomidine, bupivacaine, modified radical mastectomy, postoperative pain, visual analogue scale, regional anesthesia

Abstract

Background: Modified radical mastectomy (MRM), particularly when accompanied by axillary dissection, can cause substantial acute postoperative pain and may contribute to persistent postsurgical pain. Ultrasound-guided erector spinae plane block (ESPB) is used as a component of multimodal analgesia, and dexmedetomidine has been investigated as an adjuvant to prolong local-anaesthetic effects. Objective: To compare postoperative pain scores and rescue-analgesia requirements after MRM in patients receiving ESPB with bupivacaine plus dexmedetomidine versus bupivacaine alone. Methods: This single-centre randomized controlled trial was conducted in the Department of Anaesthesiology, ICU and Pain Management, Sir Ganga Ram Hospital, Lahore, Pakistan, from March to June 2026. Sixty women with American Society of Anesthesiologists (ASA) physical status I–II who were scheduled for elective MRM under general anaesthesia were allocated by lottery to two equal groups (n=30 each). A unilateral ultrasound-guided ESPB was performed at the T4 level after surgery. Group BD received 20 mL of 0.25% bupivacaine with dexmedetomidine 1 μg/kg, whereas Group B received 20 mL of 0.25% bupivacaine without dexmedetomidine. Pain intensity was assessed using a 10-cm visual analogue scale (VAS) at 1, 12 and 24 hours postoperatively. Results: Mean VAS scores were lower in Group BD than in Group B at 1 hour (1.2 ± 0.4 vs. 2.1 ± 0.5), 12 hours (1.5 ± 0.6 vs. 2.8 ± 0.7) and 24 hours (1.8 ± 0.5 vs. 3.1 ± 0.8); all reported between-group pain comparisons had p < 0.001. Rescue analgesia was required by 6 of 30 (20.0%) patients in Group BD and 19 of 30 (63.3%) in Group B (two-sided Fisher’s exact p=0.0014, recalculated from the reported frequencies). No clinically significant haemodynamic instability or block-related complications were reported in either group during the observation period. Conclusion: Adding dexmedetomidine to bupivacaine for ESPB was associated with lower pain scores during the first 24 postoperative hours and fewer requests for rescue analgesia after MRM. Interpretation is limited by the modest, single-centre sample and short follow-up; the findings do not establish prevention of chronic postsurgical pain or demonstrate comparative safety for uncommon adverse events.

Keywords: erector spinae plane block, dexmedetomidine, bupivacaine, modified radical mastectomy, postoperative pain, visual analogue scale, regional anesthesia

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Ayesha Siddiqa
Department of Anaesthesia, ICU and Pain Management, Sir Ganga Ram Hospital, Lahore, Pakistan
ayeshasiddiqa96@gmail.com
Muzammil Hussain
Department of Anaesthesia, ICU and Pain Management, Sir Ganga Ram Hospital, Lahore, Pakistan

How to cite:

Ayesha Siddiqa, Muzammil Hussain. Comparison of Postoperative Pain After Modified Radical Mastectomy Using Erector Spinae Plane Block with Bupivacaine Plus Dexmedetomidine versus Bupivacaine Alone. Revista Cultura Científica, 2026 Issue 24. pg. 2034-2043.

Publication History

  • Received: 11/05/2026
  • Accepted: 21/09/2026
  • Published: 15/10/2026
Copyright © 2026, Ayesha Siddiqa, Muzammil Hussain. Published by Revista Cultura Científica. This article is published as open access under the Creative Commons Attribution 4.0 International (CC BY 4.0) license (http://creativecommons.org/licenses/by/4.0/).

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