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

Amany F. Omara, MD; Sameh A. Ahmed, MD; Motaz M. A. Abusabaa, MD

doi:10.5055/jom.2021.0672

Authors

Amany F. Omara, MD https://orcid.org/0000-0002-9025-632X
Sameh A. Ahmed, MD
Motaz M. A. Abusabaa, MD

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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