Efficacy of Ketamine versus Magnesium Sulphate as Adjuvants to Levobupivacaine in Ultrasound Bilevel Erector Spinae Block in Breast Cancer Surgery (a Double-Blinded Randomized Controlled Study)

Figures & data

Figure 1 Participant flow chart of 60 female patients with breast cancer who underwent modified radical mastectomy were assessed for eligibility for our study. Twenty-patients in each group with no patient rolled out. Group (C): Control group (N=20) Group (M): magnesium sulphate group (N=20). Group (K): Ketamine group (N=20).

Table 1 Demographic and Clinical Data of the Three Studied Groups

Baseline data	Group C (n= 20)	Group M (n= 20)	Group K (n= 20)	P-value^1	P-value^2	P-value^3	P-value^4
	Mean ± SD	Mean ± SD	Mean ± SD
Age	46.10 ± 11.12	46.00 ± 8.04	43.10 ± 7.95	0.504	0.974	0.333	0.259
Weight (kg)	74.65 ± 8.21	71.70 ± 5.73	74.80 ± 5.30	0.248	0.196	0.946	0.084
Height (cm)	166.95 ± 2.87	168.10 ± 2.51	168.20 ± 1.67	0.198	0.136	0.106	0.896
BMI (kg/m^2)	26.82 ± 3.19	25.39 ± 2.09	26.44 ± 1.80	0.165	0.068	0.626	0.176
ASA
I	10 (50.0%)	11 (55.0%)	9 (45.0%)	0.819	0.752	0.752	0.527
II	10 (50.0%)	9 (45.0%)	11 (55.0%)
Side
Right	11 (55.0%)	10 (50.0%)	10 (50.0%)	0.935	0.752	0.752	1.000
Left	9 (45.0%)	10 (50.0%)	10 (50.0%)
Anesthesia duration (min)	105.00 ± 7.61	106.50 ± 7.45	106.50 ± 8.13	0.779	0.533	0.550	1.000
Surgery duration (min)	98.65 ± 8.07	99.75 ± 7.25	99.50 ± 8.71	0.902	0.653	0.751	0.922

Notes: Data expressed as (Mean ± SD) and number and percentage P-value is significant if <0.05. ANOVA test was used to compare quantitative variables among groups. Chi-square test was used to compare between qualitative variables. P1: P value between the three studied groups. P2: P value between C and M groups. P3: P value between C and K groups P4: P value between M and K groups.

Abbreviations: Group (C), control group; Group (M), magnesium sulphate group; Group (K), Ketamine group; ASA, American Society of Anesthesiologists.

Table 2 Number of Patients Requested Rescue Analgesia, Time of First Request of Analgesia, Total Morphine Amount Requested Among the Three Studied Groups During the Study Period (48 h)

	Group C (n= 20)	Group M (n= 20)	Group K (n= 20)	P-value^1	P-value^2	P-value^3	P-value^4
	Mean ± SD	Mean ± SD	Mean ± SD
Need for analgesia	20 (100.0%)	9 (45.0%)	13 (65.0%)	0.001*	0.000*	0.004*	0.204
First time analgesia (h)	7.50 ± 1.82	30.67 ± 10.58	24.92 ± 10.35	0.000*	0.000*	0.000*	0.089
Total morphine (mg)	14.40 ± 3.47	7.00 ± 0.61	7.50 ± 0.58	0.000*	0.000*	0.000*	0.642

Notes: Data expressed as (Mean ± SD) and number and percentage P-value is significant if <0.05. ANOVA test was used to compare quantitative variables among groups. Chi-square test was used to compare between qualitative variables. P1: P value between the three studied groups. P2: P value between C and M groups. P3: P value between C and K groups P4: P value between M and K groups. * Significant difference between groups.

Abbreviations: Group (C), control group; Group (M), magnesium sulphate group; Group (K), Ketamine group.

Figure 2 Visual analogue scale changes at rest (VASR) of the three studied groups during the study period (48 h). Data presented as median (range); Group (C): control group. Group (M): magnesium sulphate group. Group (K): Ketamine group. Mild outliers are marked with a circle (O) on the boxplot.

Figure 3 Visual analogue scale changes at movement (VASM) of the three studied groups during the study period (48 h). Data presented as median (range); Group (C): control group. Group (M): magnesium sulphate group. Group (K): Ketamine group. Mild outliers are marked with a circle (O) on the boxplot. Extreme outliers are marked with an asterisk (*) on the boxplot.

Table 3 Incidence of Side Effects in the Three Studied Groups

Side Effects	Group C (n= 20)	Group M (n= 20)	Group K (n= 20)	P-value^1	P-value^2	P-value^3	P-value^4
	No. (%)	No. (%)	No. (%)
Nausea	8 (40.0%)	3 (15.0%)	5 (25.0%)	0.198	0.077	0.311	0.695
Vomiting	8 (40.0%)	3 (15.0%)	5 (25.0%)	0.198	0.077	0.311	0.695
Vascular puncture	0 (0.0%)	0 (0.0%)	0 (0.0%)	--	--	--	--
Nerve injury	0 (0.0%)	0 (0.0%)	0 (0.0%)	--	--	--	--
LA toxicity	0 (0.0%)	0 (0.0%)	0 (0.0%)	--	--	--	--
Pneumothorax	0 (0.0%)	0 (0.0%)	0 (0.0%)	--	--	--	--

Notes: Data expressed as number (percentage). P-value is significant if <0.05. Chi-square test was used to compare between qualitative variables. Fisher’s exact test was used if more than 20% of cells have expected frequency less than five. P1: P value between the three studied groups. P2: P value between C and M groups. P3: P value between C and K groups. P4: P value between M and K groups.