Epidural dexmedetomidine, tramadol, or neostigmine for postoperative pain after major breast surgeries

Background It is postulated that the beneficial effects of epidural analgesia result from attenuation of stress response and provision of good postoperative analgesia. We added dexmedetomidine, tramadol, or neostigmine to bupivacaine in thoracic epidural anesthesia to evaluate their effect on perioperative cortisol level, postoperative analgesia, time to ambulation, and complications. Patients and methods Eighty female patients scheduled for major breast surgery were divided into four equal groups (20 patients each) in a randomized double-blinded manner. Thoracic epidural anesthesia was induced. In group C 15 ml of 0.5% bupivacaine (control group), in group D 15 ml of 0.5% bupivacaine +75 μg of dexmedetomidine, in group T 15 ml of 0.5% bupivacaine +75 mg of tramadol, and in group N 15 ml of 0.5% bupivacaine +75 μg of neostigmine were given. Perioperative cortisol level, postoperative analgesia, time to ambulation, and complications were assessed. Results Demographic data and surgical characteristics were similar in all groups. Patients in groups D and T had lower pain scores compared with patients in groups C and N at all time points in the following 24 h postoperatively. Hence, patients in groups D and T consumed a lower dose of bupivacaine in the postoperative period compared with patients in groups C and N. There was a highly significant reduction in the mean time to postoperative ambulation in groups D, T, and N compared with group C. Conclusion Dexmedetomidine is superior to tramadol and neostigmine in providing hemodynamic stability, excellent attenuation of stress response, prolonged postoperative analgesia, and early mobilization with minimal undesirable side effects.