Effect of Erector Spinae Block and PECS Block on Quality of Recovery and Analgesia After Modified Radical Mastectomy

Abstract

Objectives: Postoperative pain after modified radical mastectomy ranges from moderate to severe. Pectoralis block in comparison to Erector Spinae block have been found better in reducing pain scores and reducing consumption of rescue analgesic in postoperative period. This study aimed to compare the effect of Erector Spinae block and Pectoralis block on quality of recovery after Modified Radical Mastectomy using QoR-40 score. Methods: After general anaesthesia, patients were given block according to computer generated randomization. Group-I-Pectoralis block including PEC I AND PEC II(PECS), Group-II-Erector spinae block(ESP) and Group III-Control Group (No intervention). Quality of recovery (QoR-40) score was observed on morning of surgery and at 24 hrs. Time to rescue analgesia and total consumption of rescue analgesia in first 24 hrs. were also observed. Results: In the postoperative period at 24 hrs. Global QoR-40 scores were 183.64±6.36 in PECS group, 179.68± 6.38 in ESP group and 171.37±6.88 in control group. (p<0.0001) But, there was no statistically significant difference between QoR score of PECS & ESP group patients(p=0.0551). The total requirement of rescue analgesic was significantly lesser in PECS group (137.28±31.46 mg) in comparison to ESP Group(189.46±42.98mg) and control group (229.57±46.80 mg). (p<0.0001). Time to first rescue analgesia was significantly higher in PECS group (6.53±2.78 hrs) in comparison to ESP (4.05±2.91 hrs) and control group (2.15±1.51 hrs). (p<0.0001) Conclusion: Both Erector Spinae block and Pectoralis block are effective for improving QoR score and reducing consumption of rescue analgesic after modified radical mastectomy.
 Keywords: breast surgery, cancer, postoperative recovery, postoperative pain