Perform a comparison of effective pain relief duration between liposomal bupivacaine and dexmedetomidine when added to bupivacaine in a block for mastectomy for cancer surgery. The erector spinae plane block is a well-established block that is utilized for post operative pain control for procedures performed on the soft tissue of the chest and chest wall as well as intrathoracic procedures. The goal is comparison of the effective duration of both study groups to determine if there is a significant difference in time and amount of post operative opioids required which admitted to hospital.
Patients requiring any variation of mastectomy with or without axillary lymph node dissection.
Patient agrees to a peripheral nerve block.
Patient agrees to be a study participant.
APS team believes a peripheral nerve block would be appropriate for the patient after reviewing medical/surgical history.
Patient declines a peripheral nerve block.
Patient declines to be a study participant.
APS team believes a peripheral nerve block is not clinically indicated.
Surgeon does not want a peripheral nerve block.
Parallel
Dexmedetomidine
Drugblock duration extension additive
Liposomal bupivacaine
DrugControl arm, comparison for block duration with dexmedetomidine
Is bupivacaine with dexmedetomidine superior to liposomal bupivacaine in both density and duration?
Control group erector spinae plane block with liposomal bupivacaine is less dense and not as long lasting as bupivacaine with dexmedetomidine experimental group. Will investigate initial visual analog scale (VAS) pain scores to determine how effective the block is after surgery and every 6 hours while in patient. Additionally, calling the patient discharging after 96 hours from the time of the block and collect daily pain scores from the patient. This is to establish which group had best pain scores throughout and longest duration of lowest pain scores.
Evaluate oral milligram of morphine equivalent (MME).
Same control and experimental group assessing for morphine milligram equivalents reduction between groups. Will investigate milligram of morphine equivalent every 6 hours to see how much each group requires. In particular looking for increasing trend in morphine equivalence over time. Additionally, calling the patient discharging after 96 hours from the time of the block and collect daily opioid medications taken by the patient and converting to milligram morphine equivalents. This is to establish which group has taken the least amount of morphine equivalents throughout the duration of the block, as an indication to the duration of optimum benefit of the block.
Time to first opioid administration
Determine if there is a difference in time to first opioid dose after surgery when block is provided before surgery. To determine if there is a difference in the quality of the block after the surgery requiring earlier administration of opioids, as is expected with less dense block having more increased pain.
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