Erector spinae plane block versus thoracic paravertebral block for the prevention of acute postsurgical pain in breast cancer surgery: A prospective observational study compared with a propensity score-matched historical cohort

Abstract

Background Preventing acute postsurgical pain (PSP) following breast cancer surgery is a major issue. Thoracic paravertebral block (TPVB) has been widely studied for this indication. Erector spinae plane block (ESPB) has been assumed to be effective. We aimed to compare the efficacy and safety of ESPB over TPVB in preventing acute PSP. Methods In this prospective observational study, 120 patients admitted for unilateral major oncologic breast surgery received T2/T3 ESPB (ropivacaine 0.75%, 0.35 ml.kg-1), and 102 were analysed. Then, the ESPB cohort was compared to a TPVB cohort from the experimental arm of a randomized controlled study with the same protocol (NCT02408393) using propensity score matching analysis. The primary outcome was the need for morphine consumption in the PACU. Secondary outcomes were the morphine total dose, the incidence of ESPB and TPVB complications, and discontinuous visual analogue scale measurement trends at rest and at mobilization in the 24 hours after surgery. Results A total of 102 patients completed the study between December 2018 and August 2019. Propensity score matching formed 94 matched pairs. The proportion of morphine titration in the PACU was higher in the ESPB group than in the TPVB group (74.5% vs. 41.5%, p<0.001), with a between-group difference of 33.0% (95% CI [19.3%, 46.7%]). No ESPB-related complications were observed. Conclusion ESPB is less effective in preventing morphine consumption in the PACU than TPVB. Our findings do not support the use of ESPB as the first-line regional anaesthesia for major breast cancer surgery. Randomized trials comparing ESPB and TPVB are needed.

Efficacy of postoperative analgesia with intravenous paracetamol and mannitol injection, combined with thoracic paravertebral nerve block in post video-assisted thoracoscopic surgery pain: a prospective, randomized, double-blind controlled trial

“…To ensure the effectiveness and safety of postoperative analgesia, TPVB was performed by the same experienced anesthesiologists under the guidance of ultrasound. Numerous studies have confirmed that TPVB can reduce postoperative acute pain, mainly caused by the chest drain and opioid sparing after thoracic surgery [ 21 , 22 ]. One previous study showed that general anesthesia combined with TPVB can reduce postoperative pulmonary complications by reducing postoperative pain in geriatric patients undergoing thoracic surgery [ 23 ].…”

Ultrasound-Guided Serratus Posterior Superior Intercostal Plane Block in Modified Radical Mastectomy Surgeries: A Case Series

“…Premachandra et al 11 have indicated that ESP cannot replace PVB for postoperative analgesia in breast surgeries, particularly for larger surgeries involving mastectomy and axillary lymph node dissection. Additionally, the Rhomboid intercostal block provides sensory block between T3 and T9 dermatomes in MRM surgeries but does not provide similar sensory block in the axillary region.…”

Thoracic paravertebral block versus local infiltration anesthesia for percutaneous kyphoplasty to treat osteoporotic vertebral compression fractures combined with intercostal neuralgia: a randomized controlled trial

“…TPVB has a wide range of clinical application, including its use in providing anesthesia and analgesia for breast surgery, anesthesia for thoracic and upper abdominal regional surgery, as well as analgesia for multiple rib fractures and postherpetic neuralgia [27][28][29] . Our previous retrospective study suggested that TPVB is superior to LI anesthesia for providing analgesia during thoracic PKP [13] .…”