{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T20:41:56Z","timestamp":1786653716824,"version":"build-2736575974"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Opioid-sparing analgesia for acute postoperative pain after breast cancer surgery is crucial due to opioid-related side effects. The utilisation of erector spinae plane block and low-dose intravenous ketamine-dexmedetomidine are widely recognised as non-opioid analgesic methodologies. The objective of this study was to conduct a randomised trial to examine the analgesic efficacy of both approaches while minimising the use of opioids.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Seventy-two female patients scheduled for unilateral modified radical mastectomy were recruited. They were allocated randomly to Group ESPB, which received ipsilateral ultrasound-guided erector spinae plane block by 20 mL bupivacaine 0.5% at the level of T5 after induction of general anaesthesia, and Group Ket-Dex, which received intravenous (IV) bolus 0.25 mg\/kg of ketamine and 0.5 \u00b5g\/kg of dexmedetomidine, followed by an IV infusion of 0.25 mg\/kg of ketamine and 0.3 \u00b5g\/kg of dexmedetomidine per hour. Total postoperative morphine consumption (24 h) was the primary outcome. The secondary outcomes were pain scores over 24 hours during rest, duration of analgesia, isoflurane consumption, time to awakening, postoperative nausea and vomiting (PONV), and postoperative serum cortisol level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The postoperative morphine consumption over 24-hour in Group ESPB was 3.26 mg (0\u20136.74) versus 2.35 mg (2.08\u20134.88) in Group Ket-Dex (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.046). Group Ket-Dex had lower pain scores at rest, longer analgesia duration, longer awakening time, and lower postoperative serum cortisol levels.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Intravenous low-dose ketamine-dexmedetomidine infusion intraoperatively with inhalational-based general anaesthesia provides superior opioid-sparing analgesia to that of ESPB in patients undergoing unilateral non-reconstructive modified radical mastectomy, with less postoperative opioid consumption and stress response.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ija.ija_1167_23","type":"journal-article","created":{"date-parts":[[2024,6,6]],"date-time":"2024-06-06T08:04:11Z","timestamp":1717661051000},"page":"651-657","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["A randomised comparative study of erector spinae plane block versus low-dose ketamine-dexmedetomidine intravenous infusion as intraoperative opioid-free analgesia for modified radical mastectomy"],"prefix":"10.4103","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4324-5177","authenticated-orcid":false,"given":"Ahmed Medhat","family":"Mohasseb","sequence":"first","affiliation":[{"name":"Anaesthesia and Surgical Intensive Care, Department of Anaesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Mansoura University, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0981-0806","authenticated-orcid":false,"given":"Mona G.","family":"Elebiedy","sequence":"additional","affiliation":[{"name":"Anaesthesia and Surgical Intensive Care, Department of Anaesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Mansoura University, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0194-2556","authenticated-orcid":false,"given":"Mohammed N.","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Anaesthesia and Surgical Intensive Care, Department of Anaesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Mansoura University, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,6,7]]},"reference":[{"key":"R1-20260505","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.redar.2017.08.004","article-title":"Erector spinae plane block for radical mastectomy: A new indication?","volume":"65","author":"Veiga","year":"2018","journal-title":"Rev Esp Anestesiol Reanim (Engl Ed)"},{"key":"R2-20260505","doi-asserted-by":"crossref","first-page":"200","DOI":"10.4103\/ija.IJA_758_18","article-title":"Ultrasound-guided erector spinae plane block for postoperative analgesia in modified radical mastectomy: A randomised control study","volume":"63","author":"Singh","year":"2019","journal-title":"Indian J Anaesth"},{"key":"R3-20260505","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1055\/s-0038-1676477","article-title":"Pain management in enhanced recovery after surgery (ERAS) protocols","volume":"32","author":"Simpson","year":"2019","journal-title":"Clin Colon Rectal Surg"},{"key":"R4-20260505","doi-asserted-by":"crossref","first-page":"261","DOI":"10.4103\/ija.ija_773_23","article-title":"Retrolaminar block for opioid-free anaesthesia and enhanced recovery after posterior lumbar discectomy: A randomised controlled study","volume":"68","author":"Alshaimaa","year":"2024","journal-title":"Indian J Anaesth"},{"key":"R5-20260505","doi-asserted-by":"crossref","first-page":"e100178","DOI":"10.5812\/aapm.100178","article-title":"Ketamine as adjuvant for acute pain management","volume":"9","author":"Imani","year":"2019","journal-title":"Anesth Pain Med"},{"key":"R6-20260505","first-page":"GE01","article-title":"Dexmedetomidine in current anaesthesia practice- A review","volume":"8","author":"Naaz","year":"2014","journal-title":"J Clin Diagn Res"},{"issue":"Suppl 1","key":"R7-20260505","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.4103\/ija.IJA_216_21","article-title":"Dexmedetomidine and Ketamine - Comrades on an eternal journey!","volume":"65","author":"Bajwa","year":"2021","journal-title":"Indian J Anaesth"},{"key":"R8-20260505","doi-asserted-by":"crossref","first-page":"697","DOI":"10.4103\/ija.ija_581_22","article-title":"Efficacy of intravenous dexmedetomidine-lignocaine infusion compared to morphine for intraoperative haemodynamic stability in modified radical mastectomy: A randomised controlled trial","volume":"67","author":"Jose","year":"2023","journal-title":"Indian J Anaesth"},{"key":"R9-20260505","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/ANA.0000000000000193","article-title":"Comparison of small dose ketamine and dexmedetomidine infusion for postoperative analgesia in spine surgery--A prospective randomised double-blind placebo controlled study","volume":"28","author":"Garg","year":"2016","journal-title":"J Neurosurg Anesthesiol"},{"key":"R10-20260505","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/0952-8180(94)00001-K","article-title":"The post-anesthesia recovery score was revisited","volume":"7","author":"Aldrete","year":"1995","journal-title":"J Clin Anesth"},{"key":"R11-20260505","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1111\/anae.15164","article-title":"Efficacy of erector spinae plane block for analgesia in breast surgery: A systematic review and meta-analysis","volume":"76","author":"Leong","year":"2021","journal-title":"Anaesthesia"},{"key":"R12-20260505","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1111\/cns.12099","article-title":"Ketamine pharmacology: An update (pharmacodynamics and molecular aspects, recent findings)","volume":"19","author":"Mion","year":"2013","journal-title":"CNS Neurosci Ther"},{"key":"R13-20260505","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1111\/cns.12104","article-title":"Ketamine and peripheral inflammation","volume":"19","author":"De Kock","year":"2013","journal-title":"CNS Neurosci Ther"},{"key":"R14-20260505","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1016\/j.bja.2019.07.027","article-title":"Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: Systematic review and meta-analysis","volume":"123","author":"Wang","year":"2019","journal-title":"Br J Anaesth"},{"key":"R15-20260505","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.4103\/ija.IJA_8_20","article-title":"Comparison of pectoralis plane blocks with ketamine-dexmedetomidine adjuncts and opioid-based general anaesthesia in patients undergoing modified radical mastectomy","volume":"64","author":"Shah","year":"2020","journal-title":"Indian J Anaesth"},{"key":"R16-20260505","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.1213\/ANE.0000000000001652","article-title":"Perioperative anesthesia care and tumor progression","volume":"124","author":"Sekandarzad","year":"2017","journal-title":"Anesth Analg"}],"container-title":["Indian Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_1167_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:41:20Z","timestamp":1786650080000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_1167_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,7]]},"references-count":16,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/ija.ija_1167_23","relation":{},"ISSN":["0019-5049","0976-2817"],"issn-type":[{"value":"0019-5049","type":"print"},{"value":"0976-2817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,7]]},"assertion":[{"value":"2023-12-04","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-14","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}