{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T05:56:18Z","timestamp":1793944578538,"version":"4.8.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":36,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002352","name":"Ain Shams University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002352","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postoperative pain after modified radical mastectomy (MRM) can lead to significant morbidity. The erector spinae plane block (ESPB) has emerged as an effective regional anesthesia technique. This study evaluated the effect of adding dexmedetomidine to bupivacaine on postoperative analgesia following ESPB in MRM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>\n                      This double-blinded, randomized controlled trial included 60 female patients (ASA I\u2013II, age 30\u201365 years, BMI\u2009&lt;\u200935\u00a0kg\/m\u00b2) undergoing MRM at Ain Shams University Hospitals between August 2023 and July 2024. Patients were randomly allocated into two groups (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200930 each): Group B received unilateral ESPB with 20\u00a0ml of 0.5% bupivacaine, and Group BD received 10\u00a0ml of 0.5% bupivacaine plus dexmedetomidine (100\u00a0\u00b5g\/mL, 1\u00a0\u00b5g\/kg) diluted to a total volume of 20\u00a0ml with 0.9% saline. Blocks were performed postoperatively in lateral decubitus position under ultrasound guidance. Rescue analgesia consisted of IV nalbuphine 5\u00a0mg for VAS\u2009&gt;\u20094.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median (IQR) time for request of the initial dose rescue analgesia was significantly delayed in group BD compared to group B [690 (525\u2013795) versus 360 (300\u2013420), respectively, P-value\u2009&lt;\u20090.001]. The number of patients that required nalbuphine was significantly lower in group BD compared to group B (P-value\u2009=\u20090.004). The median (IQR) visual analogue scale (VAS) scores at 6\u00a0h postoperative were significantly reduced in group BD compared to group B [1 (1\u20132) versus 4 (4\u20134), P-value\u2009&lt;\u20090.001].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study\u2019s results indicated that adding dexmedetomidine to bupivacaine in ESPB enhanced its efficacy, extended postoperative pain relief, and reduced the need for nalbuphine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial registration<\/jats:title>\n                    <jats:p>The identification code in the clinicaltrials.gov database is NCT06022614, registration date: 1 September 2023, and it is also listed in the Pan African Clinical Trials Registry with the ID PACTR202307885435649, registration date: 27 July 2023. The research adhered to the CONSORT 20205 framework.<\/jats:p>\n                    <jats:p>Randomized controlled trial registered on 1 September 2023.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12893-026-03557-0","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T08:55:11Z","timestamp":1772614511000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of adding dexmedetomidine as an adjuvant to bupivacaine in ultrasound-guided erector spinae plane block for postoperative pain management following modified radical mastectomy: a randomized controlled trial"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3726-6234","authenticated-orcid":false,"given":"Abanoub Mouris","family":"Feltaoos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatem Said","family":"Abdelhamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim Youssef","family":"Kamal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf Elsayed","family":"Elagamy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0591-7147","authenticated-orcid":false,"given":"Ahmed Mostafa","family":"Abdulmageed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"issue":"6","key":"3557_CR1","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1097\/ALN.0000000000003989","volume":"135","author":"A Albi-Feldzer","year":"2021","unstructured":"Albi-Feldzer A, Dureau S, Ghimouz A, Raft J, Soubirou J-L, Gayraud G, et al. Preoperative paravertebral block and chronic pain after breast cancer surgery: a double-blind randomized trial. Anesthesiol. 2021;135(6):1091\u2013103.","journal-title":"Anesthesiol"},{"issue":"5","key":"3557_CR2","doi-asserted-by":"publisher","first-page":"425","DOI":"10.4097\/kja.20159","volume":"73","author":"U Kaur","year":"2020","unstructured":"Kaur U, Shamshery C, Agarwal A, Prakash N, Valiveru RC, Mishra P. Evaluation of postoperative pain in patients undergoing modified radical mastectomy with pectoralis or serratus-intercostal fascial plane blocks. Korean J Anesthesiol. 2020;73(5):425\u201333.","journal-title":"Korean J Anesthesiol"},{"issue":"4","key":"3557_CR3","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1097\/AAP.0000000000000101","volume":"39","author":"N Wijayasinghe","year":"2014","unstructured":"Wijayasinghe N, Andersen KG, Kehlet H. Neural Blockade for persistent pain after breast cancer surgery. Reg Anesth Pain Med. 2014;39(4):272\u2013300.","journal-title":"Reg Anesth Pain Med"},{"issue":"5","key":"3557_CR4","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1097\/AAP.0000000000000451","volume":"41","author":"M Forero","year":"2016","unstructured":"Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621\u20137.","journal-title":"Reg Anesth Pain Med"},{"issue":"8","key":"3557_CR5","doi-asserted-by":"publisher","first-page":"809","DOI":"10.4103\/ija.ija_3_25","volume":"69","author":"SA Moharam","year":"2025","unstructured":"Moharam SA, ElSharkawy MS, Almohasseb MA, Hamama K, Mahmoud MA, Abogabal MA. Ultrasound-guided external oblique intercostal plane block versus thoracic erector spinae block for post-thoracotomy pain: A randomised double-blinded non-inferior clinical study. Indian J Anaesth. 2025;69(8):809\u201315.","journal-title":"Indian J Anaesth"},{"issue":"1","key":"3557_CR6","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1186\/s12871-022-01716-3","volume":"22","author":"N Bao","year":"2022","unstructured":"Bao N, Shi K, Wu Y, He Y, Chen Z, Gao Y, et al. Dexmedetomidine prolongs the duration of local anesthetics when used as an adjuvant through both perineural and systemic mechanisms: a prospective randomized double-blinded trial. BMC Anesthesiol. 2022;22(1):176.","journal-title":"BMC Anesthesiol"},{"key":"3557_CR7","doi-asserted-by":"crossref","unstructured":"Chen Z, Liu Z, Feng C, Jin Y, Zhao X. Dexmedetomidine as an adjuvant in peripheral nerve block. Drug Des Devel Ther. 2023;17:1463\u201384.","DOI":"10.2147\/DDDT.S405294"},{"key":"3557_CR8","doi-asserted-by":"crossref","unstructured":"Steverink JG, Piluso S, Malda J, Verlaan J-J. Comparison of in vitro and in vivo toxicity of bupivacaine in musculoskeletal applications. Front Pain Res. 2021;2:723883.","DOI":"10.3389\/fpain.2021.723883"},{"issue":"4","key":"3557_CR9","first-page":"512","volume":"11","author":"SH Yousif","year":"2024","unstructured":"Yousif SH, Zanfaly HI, Galal Eldin AM. Ultrasound-guided erector spinae block versus serratus anterior block for perioperative analgesia in patients undergoing modified radical mastectomy surgery. Res Opin Anaesth Intensive Care. 2024;11(4):512\u201332.","journal-title":"Res Opin Anaesth Intensive Care"},{"issue":"2","key":"3557_CR10","doi-asserted-by":"publisher","first-page":"668","DOI":"10.21037\/atm.2019.10.74","volume":"7","author":"Z Gao","year":"2019","unstructured":"Gao Z, Xiao Y, Wang Q, Li Y. Comparison of Dexmedetomidine and dexamethasone as adjuvant for ropivacaine in ultrasound-guided erector spinae plane block for video-assisted thoracoscopic lobectomy surgery: a randomized, double-blind, placebo-controlled trial. Ann Transl Med. 2019;7(2):668\u201378.","journal-title":"Ann Transl Med"},{"issue":"32","key":"3557_CR11","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1097\/MD.0000000000026962","volume":"100","author":"J Rao","year":"2021","unstructured":"Rao J, Gao Z, Qiu G, Gao P, Wang Q, Zhong W, et al. Nalbuphine and Dexmedetomidine as adjuvants to ropivacaine in ultrasound-guided erector spinae plane block for video-assisted thoracoscopic lobectomy surgery: A randomized, double-blind, placebo-controlled trial. Med (Baltim). 2021;100(32):269\u2013362.","journal-title":"Med (Baltim)"},{"issue":"1","key":"3557_CR12","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/AJP.0000000000000992","volume":"38","author":"Q Wang","year":"2021","unstructured":"Wang Q, Li H, Wei S, Zhang G, Ni C, Sun L, et al. Dexmedetomidine added to ropivacaine for ultrasound-guided erector spinae plane block prolongs analgesia duration and reduces perioperative opioid consumption after thoracotomy: A randomized, controlled clinical study. Clin J Pain. 2021;38(1):8\u201314.","journal-title":"Clin J Pain"},{"issue":"1","key":"3557_CR13","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s12871-023-02014-2","volume":"23","author":"MA Hamed","year":"2023","unstructured":"Hamed MA, Fargaly OS, Abdelghaffar RA, Moussa MA, Algyar MF. The role of Dexmedetomidine as an adjuvant for high-thoracic erector spinae plane block for analgesia in shoulder arthroscopy; a randomized controlled study. BMC Anesthesiol. 2023;23(1):53\u20136.","journal-title":"BMC Anesthesiol"},{"issue":"2","key":"3557_CR14","doi-asserted-by":"publisher","first-page":"227","DOI":"10.4103\/joacp.JOACP_366_16","volume":"34","author":"S Manzoor","year":"2018","unstructured":"Manzoor S, Taneja R, Sood N, Puri A, Kadayaprath G. Comparative study to assess the quality of analgesia of bupivacaine and bupivacaine with Dexmedetomidine in ultrasound-guided pectoral nerve block type I and II in breast surgeries. J Anaesthesiol Clin Pharmacol. 2018;34(2):227\u201331.","journal-title":"J Anaesthesiol Clin Pharmacol"},{"issue":"2","key":"3557_CR15","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.bjan.2018.11.002","volume":"69","author":"C Bi\u00e7er","year":"2019","unstructured":"Bi\u00e7er C, \u00dcnalan EN, Aksu R, \u00d6nal \u00d6, G\u00fcne\u015f I. [Addition of Dexmedetomidine to bupivacaine in ultrasonography-guided paravertebral Blockade potentiates postoperative pain relief among patients undergoing thoracotomy]. Braz J Anesthesiol. 2019;69(2):144\u201351.","journal-title":"Braz J Anesthesiol"},{"issue":"2","key":"3557_CR16","first-page":"512","volume":"6","author":"M Gad","year":"2019","unstructured":"Gad M, Elmetwally M. Efficacy of adding Dexmedetomidine as adjuvant with Levobupivacaine in ultrasound-guided serratus plane block for modified radical mastectomy surgery. Res Opin Anaesth Intensive Care. 2019;6(2):512\u201332.","journal-title":"Res Opin Anaesth Intensive Care"},{"issue":"3","key":"3557_CR17","doi-asserted-by":"publisher","first-page":"293","DOI":"10.4103\/sja.SJA_624_16","volume":"11","author":"SK Packiasabapathy","year":"2017","unstructured":"Packiasabapathy SK, Kashyap L, Arora MK, Batra RK, Mohan VK, Prasad G, et al. Effect of Dexmedetomidine as an adjuvant to bupivacaine in femoral nerve block for perioperative analgesia in patients undergoing total knee replacement arthroplasty: A dose-response study. Saudi J Anaesth. 2017;11(3):293\u20138.","journal-title":"Saudi J Anaesth"},{"issue":"1","key":"3557_CR18","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1186\/s12871-022-01716-3","volume":"22","author":"N Bao","year":"2022","unstructured":"Bao N, Shi K, Wu Y, He Y, Chen Z, Gao Y, et al. Dexmedetomidine prolongs the duration of local anesthetics when used as an adjuvant through both perineural and systemic mechanisms: a prospective randomized double-blinded trial. BMC Anesthesiol. 2022;22(1):176\u201387.","journal-title":"BMC Anesthesiol"},{"issue":"8","key":"3557_CR19","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.2147\/DDDT.S405294","volume":"17","author":"Z Chen","year":"2023","unstructured":"Chen Z, Liu Z, Feng C, Jin Y, Zhao X. Dexmedetomidine as an adjuvant in peripheral nerve block. Drug Des Devel Ther. 2023;17(8):1463\u201384.","journal-title":"Drug Des Devel Ther"}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12893-026-03557-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-026-03557-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-026-03557-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:19:38Z","timestamp":1781637578000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12893-026-03557-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,4]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3557"],"URL":"https:\/\/doi.org\/10.1186\/s12893-026-03557-0","relation":{},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,4]]},"assertion":[{"value":"17 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The approval for the clinical trial was acquired from the Research Ethical Committee (REC) at the Faculty of Medicine, Ain Shams University, Cairo, Egypt (FMASU MD145\/2023). Before enrollment, all participants provided documented informed consent. Participation in the study was optional, and confidentiality and privacy were guaranteed. The Helsinki Declaration and its following amendments set forth the relevant ethical norms, directives, and laws, which were followed in executing all the study's techniques.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"251"}}