Efficacy of Dexmedetomidine as an Adjuvant with Ropivacaine in Paravertebral Block in Surgery for Breast Cancer - A Study of 50 Cases

Background: Effective postoperative pain control after breast cancer surgery is essential to reduce morbidity, opioid consumption, and patient discomfort. Thoracic paravertebral block (TPVB) is an established regional anesthesia technique that provides unilateral analgesia with minimal systemic effects. Ropivacaine is commonly used for TPVB due to its favorable safety profile. Dexmedetomidine, a highly selective α₂-adrenergic agonist, has been increasingly used as an adjuvant to local anesthetics to enhance analgesic efficacy. This study evaluated the efficacy of dexmedetomidine as an adjuvant to ropivacaine in TPVB for patients undergoing modified radical mastectomy. Material and Methods: This prospective, randomized, controlled study was conducted on 50 female patients aged ≥18 years, belonging to ASA physical status I–III, scheduled for modified radical mastectomy. Patients were randomly allocated into two groups: Group PR received TPVB with 0.5% ropivacaine, while Group PRD received TPVB with 0.5% ropivacaine plus dexmedetomidine (1 μg/kg). TPVB was performed at T1, T3, and T5 levels before induction of general anesthesia. Primary outcomes included duration of analgesia and total postoperative opioid consumption. Secondary outcomes included onset of sensory block, hemodynamic parameters, and postoperative pain scores using the Visual Analogue Scale (VAS), Ramsay Sedation Scores, patient satisfaction, and adverse effects. Results: Group PRD demonstrated a significantly faster onset of sensory block, prolonged duration of analgesia, lower postoperative VAS scores at all time intervals, and significantly reduced tramadol consumption compared to Group PR (p < 0.001). Hemodynamic parameters showed a controlled and stable reduction in heart rate and blood pressure in the dexmedetomidine group without clinical instability. Patient satisfaction was higher in Group PRD, with no significant increase in adverse effects. Conclusion: Dexmedetomidine as an adjuvant to ropivacaine in TPVB significantly improves postoperative analgesia, reduces opioid requirement, and enhances patient satisfaction without increasing complications.