Efficacy and safety of ketamine added to local anesthetic in modified pectoral block for management of postoperative pain in patients undergoing modified radical mastectomy

Background: breast surgery is an exceedingly common procedure with an increased incidence of acute and chronic pain. pectoral nerve block is a novel peripheral nerve block alternative to neuro-axial and paravertebral blocks for ambulatory breast surgeries. objectives: this study aims to compare the analgesic efficacy and safety of modified pecs block with ketamine plus bupivacaine versus bupivacaine in patients undergoing breast cancer surgery. study design: a randomized,double-blind,prospective study. setting: academic medical center. methods: this study is registered at www.clinicaltrials.gov under number: (nct02620371) after approval by the ethics committee of south egypt cancer institute,assuit university,assuit,egypt. sixty patients aged 18 – 60 years scheduled for modified radical mastectomy were enrolled and randomly assigned into 2 groups (30 patients each): control group patients were given ultrasound-guided,pecs block with 30 ml of 0.25% bupivacaine only. ketamine group patients were given ultrasound-guided,pecs block with 30 ml of 0.25% bupivacaine plus ketamine hydrochloride (1 mg/kg). patients were followed up for 48 hours postoperatively for vital signs,vas score,first request of rescue analgesia and total morphine consumption,sedation score,and side effects. results: ketamine plus bupivacaine in pecs block compared to bupivacaine alone prolonged the mean time of first request of analgesia (18.25 ± 1.98),(12.56 ± 2.64),respectively (p < 0.001),reduced total morphine consumption (12.50 ± 4.63),(18.86 ± 6.28),respectively (p = 0.016). with no significant difference in hemodynamics,respiratory rate,oxygen saturation,vas and sedation scores,and side effects observed between the 2 groups (p > 0.05). limitations: this study is limited by its sample size. conclusion: the addition of ketamine to modified pecs block prolonged the time to first request of analgesia and reduced total opioid consumption without serious side effects in patients who underwent a modified radical mastectomy. © 2016,american society of interventional pain physicians. all rights reserved.