Maedica (Bucur). 2026 Mar;21(1):12-20. doi: 10.26574/maedica.2026.21.1.12.
ABSTRACT
OBJECTIVES: Postoperative pain following breast surgery remains a significant clinical challenge and may delay recovery while increasing the need for systemic analgesics. Dexmedetomidine, a selective α-2 adrenergic receptor agonist, has been shown to enhance the analgesic effects of local anesthetics. This randomized comparative study aimed to evaluate the analgesic efficacy of dexmedetomidine administered alone or in combination with ropivacaine in patients undergoing modified radical mastectomy.
MATERIALS AND METHODS: This prospective randomized trial was conducted in Hippokrateio Hospital of Athens, Greece, between October 2021 and September 2022, in the first Propaedeutic Surgical Clinic, National and Kapodistrian University of Athens. Ninety female patients (Angle Side Angle – ASA I-II) aged 25-65 years old, who had been scheduled for modified radical mastectomy, were randomized into three groups (n = 30 each). Group R received 0.375% ropivacaine, Group D, dexmedetomidine (1 μg/kg) and Group RD, a combination of both agents. A standardized volume of 10 mL was infiltrated using a landmark-guided technique along the anatomical course of the long thoracic nerve and the adjacent peri-incisional fascial plane before wound closure. Postoperative pain was evaluated using the visual analog scale (VAS) at 0, 4, 8, 16, and 24 hours and only at rest measured in our study. Rescue analgesia with intravenous paracetamol and tramadol was recorded. Statistical analysis included one-way and repeated-measures ANOVA, with significance set at p < 0.05.
RESULTS: The RD group demonstrated clinically meaningful threshold VAS scores at all-time points (p < 0.001) and required substantially less rescue analgesia than Groups R and D, confirming the additive analgesic effect of dexmedetomidine when combined with ropivacaine.
CONCLUSIONS: The combination of dexmedetomidine and ropivacaine significantly improves postoperative analgesia following modified radical mastectomy without increasing adverse effects. Dexmedetomidine appears to be a safe and effective adjuvant within multimodal analgesia strategies.
PMID:41978866 | PMC:PMC13061461 | DOI:10.26574/maedica.2026.21.1.12
