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Pain after thoracotomy is one of the most severe pains after surgery. Respiratory muscle splinting due to poor control of post-operative pain may lead to respiratory complications and delayed recovery. In studies addition of dexmedetomidine or fentanyl to local anaesthetics showed enhanced quality of anaesthesia, reduced post-operative analgesic requirement and improved quality and duration of sensory neural blockade. But there are very few studies comparing dexmedetomidine and fentanyl as an adjuvant to ropivacaine in paravertebral block for post thoracotomy analgesia. 80 patients scheduled to undergo elective thoracotomy were randomly divided into two groups. Group A patients received infusion of 0.2% ropivacaine + 2µg/ml(microgram/millilitre) fentanyl @ 0.1ml/kg/h(millilitre/kilogram/hour) and Group B patients received infusion of 0.2% ropivacaine + 1µg/ml dexmedetomidine @ 0.1ml/kg/h in continuous paravertebral block. The patients had visual analogue scale(VAS) at rest between 1-3 in fentanyl group and 1-2 in dexmedetomidine group.(p value >0.05) The mean VAS score for the severity of pain at coughing was between 2-3 in fentanyl group and 1-2.5 in dexmedetomidine group and the difference is statistically significant.(p value <0.05) 12 patients in fentanyl group received rescue analgesic compared to 4 patients in dexmedetomidine group.(p value <0.05) Total fentanyl consumption was more in fentanyl group compared to dexmedetomidine group.(p value >0.05) There was no difference in incidence of side effects in both groups.(p value >0.05) Dexmedetomidine as an adjuvant to ropivacaine provided better post-operative analgesia during coughing and significantly reduced the requirement of rescue analgesic in comparison to fentanyl group without any significant adverse effects. [ABSTRACT FROM AUTHOR]

Aim & objectives: To compare safety and efficacy of ultrasound guided modified pectoral nerve block (PECS block) and paravertebral (PVB) block in patients undergoing modified radical mastectomy. Methodology: In this prospective, randomized, single blind study, sixty ASA class I-II patients posted for modified radical mastectomy were randomly allocated one of the two groups; Group 1 and Group 2 each with thirty patients. Both the groups received ultrasound guided blocks. Patients of Group 1 received PVB and Group 2 received PECS block. Results: Both the groups were comparable with respect to initial characteristics like age, weight, height, BMI, ASA class. Intraoperatively both the blocks were comparable in consumption of fentanyl use. Postoperatively PVB group received more tramadol (rescue analgesic) in comparison to Modifies PECS block group. Postoperatively PVB group received more ondansetron compare to Modified PECS block in initial 12 h. At 24 h postoperatively both the groups were comparable in total tramadol and ondansetron used. Both the blocks were comparable in terms of VAS score at rest and VAS score during physiotherapy at 24 h. Episodes of hypotension were more with PVB as it also causes sympathetic block. Conclusion Ultrasound guidance has brought a revolution in the field of nerve blocks because it is now possible to directly visualise the muscular planes, the advancing needle and the spread of local anesthetic solution during injection in real time. With our experience we suggest Modified PECS block better alternative in breast surgeries. Larger RCTs are required to establish the fact. [ABSTRACT FROM AUTHOR]