Efficacy of dexamethasone as an adjuvant to ropivacaine versus ropivacaine alone in ultrasound-guided erector spinae plane block for post-operative analgesia in modified radical mastectomy: A randomized controlled trial

Efficacy of dexamethasone as an adjuvant to ropivacaine versus ropivacaine alone in ultrasound-guided erector spinae plane block for post-operative analgesia in modified radical mastectomy: A randomized controlled trial - Background and Aims: Effective postoperative pain management is crucial for improving recovery and patient satisfaction, particularly following Modified Radical Mastectomy (MRM) surgery. Traditional opioid analgesia often results in side effects like nausea and sedation, prompting the need for alternative strategies. The ultrasound-guided Erector Spinae Plane Block (ESPB) has emerged as a promising technique for providing reliable analgesia for thoracic and abdominal surgeries, including MRM, with minimal complications. Ropivacaine, a long-acting local anesthetic, is commonly used in ESPB but may benefit from the addition of adjuvants such as Dexamethasone, known for its anti-inflammatory and analgesic properties. This study aimed to compare the efficacy of Dexamethasone as an adjuvant to Ropivacaine versus Ropivacaine alone in providing postoperative analgesia for MRM surgery. Materials and Methods: This randomized controlled trial was conducted at a tertiary care hospital involving 64 patients scheduled for Modified Radical Mastectomy (MRM) surgery. After obtaining ethical approval and informed consent, participants were randomly assigned into two groups: Group RD (Ropivacaine with Dexamethasone) and Group RS (Ropivacaine alone). In Group RD, patients received a combination of 0.5% Ropivacaine and 8 mg of Dexamethasone, while Group RS received only 0.5% Ropivacaine. The primary outcomes measured were the time to first rescue analgesia and the total analgesia required within the first 24 hours following surgery. Secondary outcomes included pain scores assessed using the Visual Analog Scale (VAS) at 4, 6, 12, and 24 hours post-surgery, as well as the incidence of any adverse events. Data was analysed using appropriate statistical methods, including t-tests and chi-square tests, with a significance level set at P Results: Group RD (Ropivacaine with Dexamethasone) demonstrated a significantly longer time to first rescue analgesia compared to Group RS (Ropivacaine alone). Additionally, Group RD required less total analgesia within the first 24 hours post-surgery than Group RS. Pain scores, assessed using the Visual Analog Scale (VAS), were significantly lower in Group RD at 4, 6, 12, and 24 hours post-surgery (P Conclusion: The addition of Dexamethasone to Ropivacaine in ultrasound-guided Erector Spinae Plane Block (ESPB) significantly improves postoperative analgesia in patients undergoing Modified Radical Mastectomy (MRM) surgery. This combination results in prolonged analgesic effects, less total analgesic consumption, and lower pain scores compared to Ropivacaine alone. Keywords: Erector spinae plane block, Ropivacaine, Dexamethasone, Ultrasound guided.