Role of ultralow dose of naloxone as an adjuvant to fentanyl–bupivacaine in thoracic paravertebral block analgesia after modified radical mastectomy: Randomized controlled trial

Authors

DOI:

https://doi.org/10.5055/jom.2021.0672

Keywords:

naloxone, pain, paravertebral, post-mastectomy, antagonist

Abstract

Objective: We evaluated the effect of the addition of 100 ng of naloxone to fentanyl–bupivacaine mixture used in thoracic paravertebral block (PVB) on the duration and the quality of post-mastectomy analgesia.

Design: A randomized double-blinded trial.

Setting: Oncology surgery unit.

Patients and participants: This study included 135 patients, aged 40-60 years of either sex presented for elective unilateral-modified radical mastectomy.

Interventions: Patients were divided randomly into three groups: group I, received 0.3 mL/kg of 0.25 percent bupivacaine; group II, received 0.3 mL/kg of 0.25 percent bupivacaine, fentanyl 50 μg, and naloxone 100 ng; group III, received 0.3 mL/kg of 0.25 percent bupivacaine and fentanyl 50 μg.

Main outcome measure(s): The visual analog scale was assessed immediately post-operative, every 2 hours till 12 hours, and then every 6 hours for 24 hours; the time of first and total amount of rescue analgesia and side effects during the first 24 hours were recorded.

Results: Group II showed a significant prolonged analgesia with a delayed first request of rescue analgesia and lower amount of morphine (592.1 ± 14.9 minutes and 7.28 ± 7.81 mg, respectively) than groups I (127.7 ± 35.1 minutes and 19.84 ± 2.56 mg, respectively) and III (232.2 ± 9.27 minutes and 13.52 ± 1.74 mg, respectively) as p < 0.001.

Conclusion: Using naloxone as additives in PVB has been promising and effective in controlling post-mastectomy pain.

Author Biographies

Amany F. Omara, MD

Anesthesia, Intensive Care & Pain Medicine Department, Faculty of Medicine, Tanta University, Egypt

Sameh A. Ahmed, MD

Anesthesia, Intensive Care & Pain Medicine Department, Faculty of Medicine, Tanta University, Egypt

Motaz M. A. Abusabaa, MD

Anesthesia, Intensive Care & Pain Medicine Department, Faculty of Medicine, Tanta University, Egypt

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Published

09/01/2021

How to Cite

Omara, MD, A. F., S. A. Ahmed, MD, and M. M. A. Abusabaa, MD. “Role of Ultralow Dose of Naloxone As an Adjuvant to fentanyl–bupivacaine in Thoracic Paravertebral Block Analgesia After Modified Radical Mastectomy: Randomized Controlled Trial”. Journal of Opioid Management, vol. 17, no. 5, Sept. 2021, pp. 389-96, doi:10.5055/jom.2021.0672.