EFFICACY OF ERECTOR SPINAE PLANE BLOCK USING ROPIVACAINE-DEXMEDETOMIDINE COMBINATION VERSUS ROPIVACAINE ALONE IN ADULT FEMALES UNDERGOING BREAST ONCOSURGERY –A RANDOMIZED CONTROLLED TRIAL

Breast cancer is the most commonly diagnosed cancer in women in India as per the National Cancer Registry Programme (NCRP) 2020 report by the Indian Council of Medical Research making Modified Radical Mastectomy (MRM) and flap reconstruction, the most commonly performed surgeries. MRM is usually done under general anesthesia (GA) using intravenous opioids but the incidence of moderate to severe postoperative pain after mastectomy under GA is high. ESP (Erector Spinae Plane) block in breast surgeries has been found to effectively reduce post operative pain and opioid consumption. Bupivacaine, a long-acting amide local anaesthetic, has been widely utilized in ESP blocks, demonstrating consistently favourable outcomes in terms of pain control and opioid-sparing effects. Ropivacaine, a long-acting amide local anaesthetic is an alternative to Bupivacaine and has superior cardiovascular safety profile with comparable analgesic efficacy. Structurally similar to Bupivacaine but less lipophilic, Ropivacaine has a lower propensity for central nervous system and cardiac toxicity, making it particularly suitable for patients with cardiovascular risk factors. Duration of analgesia with Ropivacaine alone is around 10-12 hours, Dexmedetomidine acts synergistically with LA (Local Anaesthetics) by prolonging the duration of sensory blockade, reducing nociceptive transmission, and attenuating central sensitization. Its analgesic properties contribute to reduced opioid requirements and improved patient comfort without significant respiratory depression.