The aim of this study is to evaluate the addition of tramadol combined with levobupivacaine in the reduction of postoperative pain, postoperative opioid consumption after modified radical mastectomy surgery.
Breast surgeries are usually associated with sever postoperative pain ,good perioperative analgesic technique after breast surgery is always questionable Thoracic epidural and paravertebral blocks became the gold standard techniques for pain relief, however they may be associated with complications such as spinal cord injury, total spinal anesthesia ,inadvertent intravascular injection and pneumothorax. Pecs block is less invasive procedure involving ultrasound guided inter-fascial injections which has been suggested as potential alternative analgesic technique. The block produces excellent analgesia and can be used as a rescue block in cases where the analgesia provided by the paravertebral or epidural was patchy or ineffective . Different drugs, including opioids, non-steroidal anti-inflammatory drugs, ketamine, clonidine, and neostigmine, have been added to local anesthetics to improve the duration and quality of analgesia.Tramadol has also been used for pain management of patients. The power of this clinical trial was prospectively calculated using the G Power analysis program. Using a priory power analysis with accuracy mode calculations with visual analogue score (VAS) as the primary variant and assuming type I error protection of 0.05 and an effect size convention of 0.9, a total sample size of 54 patients (27 patients in each group) produced a power of 0.90. To protect against drop out cases we added 6 cases to the total number (total of 60 cases)
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
QUADRUPLE
Enrollment
60
Ultrasound guided Pecs block will be performed using 20 ml of levobupivacaine
Ultrasound guided Pecs block will be performed using 20 ml of levobupivacaine in conjunction with tramadol
Mansoura University, Mansoura Oncology Center
Al Mansurah, DK, Egypt
Postoperative pain
Postoperative pain will be assessed by utilizing visual analogue scale (VAS)
Time frame: For the first 24 hours after surgery
Changes in heart rate
Time frame: For one hour after surgery
Changes in blood pressure
Time frame: For one hour after surgery
Changes in peripheral oxygen saturation
Time frame: For one hour after surgery
Changes in end-tidal carbon dioxide tension
Time frame: For one hour after surgery
Time for first analgesic request from extubation
Time frame: for 24 hours after surgery
Total analgesics received for 24 hrs after surgery
Time frame: for 24 hours after surgery
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