Efficacy of single-shot ultrasound-guided erector spinae plane block for postoperative analgesia after mastectomy: A randomized controlled study

Seelam, Suresh; Nair, Abhijit; Christopher, Asiel; Upputuri, Omkar; Naik, Vibhavari; Rayani, Basanth Kumar

doi:10.4103/sja.sja_260_19

Cited by 33 publications

(31 citation statements)

References 26 publications

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“…The number of patients per group in each study varied from 20 to 50. Among these 11 trials, 9 [ 16 – 22 , 24 , 26 ] of them included modified radical mastectomy, with sentinel lymph node biopsy in two trials [ 16 , 18 ] and axillary lymph node dissection in three trials [ 16 , 18 , 20 ]. Except for the study by Elsabeeny et al [ 17 ], the rest of the included studies showed that ESPB was performed by ultrasound before the induction of general anesthesia with or without preoperative sedation.…”

Section: Resultsmentioning

confidence: 99%

“…The control group of one trial was treated with 0.9% physiological saline as sham block [ 26 ], the other control groups were received no intervention. Among these 11 trials, seven [ 16 – 19 , 21 , 22 , 24 ] of them used bupivacaine, and six used bupivacaine at a concentration of 0.25% for their block. Four [ 20 , 23 , 25 , 26 ] of them were given ropivacaine.…”

Section: Resultsmentioning

confidence: 99%

“…Assessment of sensory block was performed for mapping the block area in three trials, all blocks performed in these studies were successful [ 23 – 25 ]. In most studies, postoperative pain was provided by patient-controlled intravenous analgesia with morphine, while three trials [ 17 , 20 , 22 ] used morphine and flurbiprofen axetil as single-dose rescue analgesic. There were no complications associated with nerve block reported in any trials, such as vascular puncture, pneumothorax, or local anesthesia toxicity.…”

Section: Resultsmentioning

confidence: 99%

“… N fentanyl 2 mg/kg, tramadol, paracetamol morphine PCA paracetamol 1 mg for every 6 h Not reported 25 GA group: Received no intervention He 2020 [ 20 ] MRM ± ALND Before induction of GA 20 ESPB group: 0.5%ropivacaine 20 ml at the vertebral T3 level N N/S Flurbiprofen axetil prn Not reported 20 GA group: Received no intervention Li 2020 [ 21 ] MRM Before induction of GA 30 ESPB group: 0.25% bupivacaine 30 ml at T3-T5 vertebral level. N fentanyl morphine PCA Not reported 30 GA group: Received no intervention Seelam 2020 [ 22 ] MRM Before induction of GA 50 ESPB group: 0.25% bupivacaine 30 ml T4 transverse process N fentanyl 1.5μg/kg Morphine prn paracetamol 1 g TID Not reported 50 GA group: Received no intervention Sharma 2020 [ 23 ] total mastectomy + ALND Before induction of GA 30 ESPB group: 0.5%ropivacaine 20 ml, 0.4 mL/kg the T5 level Y fentanyl 1μg/kg, diclofenac 1.5 mg/kg morphine PCA paracetamol 1 g TID Not reported 30 GA group: Received no intervention Singh 2019 [ 24 ] MRM Before induction of GA 20 ESPB group: 0.5% bupivacaine 20 ml at the T5 vertebral level Y morphine 0.1 mg/kg morphine PCA, diclofenac 1.5 mg/kg TID Not reported ...…”

Section: Resultsmentioning

confidence: 99%

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Analgesic efficacy and safety of erector spinae plane block in breast cancer surgery: a systematic review and meta-analysis

Zhang

Liu

et al. 2021

BMC Anesthesiol

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Background Surgical resection is considered to be the primary and most effective therapy for breast cancer, postoperative pain is an issue gaining significant attention. In recent years, erector spinae plane block (ESPB) has attracted much attention in postoperative analgesia, but its effectiveness is still controversial. This meta-analysis was implemented to verify the clinical analgesic efficacy and safety of erector spinae plane block in patients undergoing breast cancer surgery. Methods We searched PubMed, EMBASE, Web of Science, the Cochrane Library and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing ESPB with general anesthesia (GA) in breast cancer surgery that were published before December 25, 2020. The primary outcome was opioid consumption at the first 24 h after surgery, while secondary outcomes included pain scores at 1, 6,12 and 24 h after surgery, opioid consumption at 1, 6 and 12 h after surgery, intraoperative opioid consumption, number of patients who need for rescue analgesia, and the incidence of postoperative nausea and vomiting (PONV). Results Eleven randomized controlled trials involving 679 patients met the study inclusion criteria and were included in this study. In comparison to GA group, the ESPB group showed a significant reduction in morphine consumption at the first 24 h after surgery by a mean difference (MD) of − 7.67 mg [95% confidence interval (CI) − 10.35 to − 5.00] (P < 0.01). In addition, the ESPB group showed lower pain scores than the GA group in the four time periods (1, 6, 12 and 24 h after surgery). ESPB group significantly reduce the intraoperative consumption of fentanyl, the need for postoperative rescue analgesia, and the incidence of PONV. Conclusions Ultrasound-guided ESPB is an effective approach for reducing morphine consumption and pain intensity within the first 24 h after breast cancer surgery, compared with GA alone.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Analgesic efficacy and safety of erector spinae plane block in breast cancer surgery: a systematic review and meta-analysis

Zhang

Liu

et al. 2021

BMC Anesthesiol

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“…They documented its perioperative analgesic efficacy and its role in reducing postoperative morphine consumption. [19][20][21] Moreover, a systematic review was done by Elhawary and colleagues to investigate the role of ESPB in breast surgeries. They concluded that it is a simple technique which can be easily performed under ultrasound guidance, with a valuable role in controlling postoperative pain and reducing opioid consumption.…”

mentioning

confidence: 99%

<p>Perioperative Analgesic Modalities for Breast Cancer Surgeries: A Prospective Randomized Controlled Trial</p>

Elsabeeny¹,

Shehab²,

Wadod³

et al. 2020

JPR

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Purpose Various analgesic modalities are adopted for perioperative analgesia in breast cancer surgeries. This study aimed to compare the efficacy of intravenous morphine versus serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) in breast cancer surgeries. Patients and Methods Seventy-five breast cancer patients undergoing modified radical mastectomy from January 2020 to June 2020 were randomly allocated into 3 groups; the morphine group received morphine 0.1 mg/kg, the SAPB group received ultrasound-guided SAPB with 25 mL bupivacaine 0.25% and the ESPB group received ultrasound-guided ESPB with 25 mL bupivacaine 0.25%. A visual analogue scale (VAS) 0–10 was used to evaluate pain postoperatively, where 0 denotes no pain and 10 worst pain. If any patient in the 3 studied groups reported breakthrough pain with VAS ≥ 4 then a bolus of 3 mg morphine was given. Results There was no difference in VAS scores between the 3 groups postoperatively. Morphine consumption was higher in the morphine group (9.19 ± 2.32 mg) than the SAPB group (4.00 ± 1.55 mg) and the ESPB group (4.20 ± 1.64 mg), respectively. First time to receive postoperative morphine was significantly longer for the ESPB and SAPB groups than the morphine group (20.40 ± 4.98 hours), (19.00 ± 5.9 hours), (5.00 ± 4.62 hours), respectively. Intraoperative hemodynamics and fentanyl consumption showed no difference between groups, whereas postoperative mean arterial blood pressure values at 2 and 4 hours were higher in the morphine group. Ramsay sedation score and postoperative nausea and vomiting values in the post anesthesia care unit were higher for the morphine group compared to the SAPB and ESPB groups. No complications related to the blocks were reported. Conclusion SAPB and ESPB can be used as an effective and safe alternative to opioids with fewer side effects in breast cancer patients undergoing modified radical mastectomy. Trial Registration This trial was prospectively registered at Clinical Trials.gov on 22 January 2020 with registration number NCT04248608 ( https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009JS5&selectaction=Edit&uid=U0004LIG&ts=7&cx=−81xkwa ).

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Erector spinae plane block for postoperative pain

Schnabel,

Weibel,

Pogatzki-Zahn

et al. 2023

Cochrane Database of Systematic Reviews

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Efficacy of single-shot ultrasound-guided erector spinae plane block for postoperative analgesia after mastectomy: A randomized controlled study

Cited by 33 publications

References 26 publications

Analgesic efficacy and safety of erector spinae plane block in breast cancer surgery: a systematic review and meta-analysis

Analgesic efficacy and safety of erector spinae plane block in breast cancer surgery: a systematic review and meta-analysis

<p>Perioperative Analgesic Modalities for Breast Cancer Surgeries: A Prospective Randomized Controlled Trial</p>

Erector spinae plane block for postoperative pain

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