Role of erector spinae plane block versus paravertebral block in pain control after modified radical mastectomy. A prospective randomised trial

Abstract

Background and Aims:Thoracic paravertebral block (TPVB) provides effective analgesia in breast surgery. Recently, use of erector spinae plane block (ESPB) in controlling post-operative pain has proved effective. This study aimed to compare the effect of ESPB with TPVB in post-mastectomy acute pain control.Methods:A prospective, randomised double-blinded study enrolled 70 adult female patients, scheduled for modified radical mastectomy. Patients were randomised into two groups, receiving 20 ml of 0.25% bupivacaine: group I (TPVB) and group II (ESPB). Post-operative 24 h morphine consumption, intra-operative fentanyl consumption, time of the first request for analgesia and post-operative visual analogue scale (VAS), heart rate (HR), mean blood pressure (MBP) and complications were recorded.Results:Post-operative 24 h morphine consumption and time of the first request for analgesia were comparable between both groups (P = 0.32 and 0.075, respectively). There was no significant difference in the intra-operative fentanyl consumption. There was also no significant difference in VAS between both groups over the 24 h of study. Four patients in group I developed pneumothorax with no significant differences between both groups (P = 0.114). Incidence of nausea and vomiting was comparable between both groups. All patients displayed a stable haemodynamic profile.Conclusion:Both TPVB and ESPB can be effectively used in controlling post-mastectomy pain and reduce intra-operative and post-operative opioid consumption.

Pectoral Nerve Block and Erector Spinae Plane Block and Post-Breast Surgery Complications

“…In the study of Gad et al, pain score and the frequency of analgesics use in the SEP group was higher than in the Pecs group, which was consistent with the results of the present study (16). A clinical trial by Ghamry and Amer (17) aimed at examining the role of erector spinae plane block (ESPB) versus paravertebral block in the control of postoperative pain after mastectomy showed no significant difference in pain score between the two groups within 24 hours (2,4,6). No pain was reported at 8, 12, 18, and 24 hours after surgery, and pain intensity began to increase at 3 to 6 hours after surgery, and pain intensity was significantly different between the two groups at 6 hours after surgery (17).…”

“…In the study of Ghamry and Amer, there was no significant difference between the two groups in terms of postoperative morphine use (17). Altiparmak et al in their study also showed that morphine use decreased by up to 65% in the ESPB group within 24 hours after surgery, although there was no difference in the severity of pain between the two groups (21).…”

“…A clinical trial by Ghamry and Amer (17) aimed at examining the role of erector spinae plane block (ESPB) versus paravertebral block in the control of postoperative pain after mastectomy showed no significant difference in pain score between the two groups within 24 hours (2,4,6). No pain was reported at 8, 12, 18, and 24 hours after surgery, and pain intensity began to increase at 3 to 6 hours after surgery, and pain intensity was significantly different between the two groups at 6 hours after surgery (17). In a clinical trial by Fang et al, no significant difference was found between the ESPB and thoracic paravertebral block (TPVB) groups during the first two days after surgery (18).…”

<p>Erector Spinae Plane Block and Paravertebral Block for Breast Surgery: A Retrospective Propensity-Matched Noninferiority Trial</p>

“…These findings are consistent with the results of previous studies. 11,13 Gürkan et al compared 3 groups of patients who received ESPB, TPVB or no intervention before unilateral breast surgery and found that morphine consumption for 24 h postoperatively was similar between both block groups, but was significantly smaller in both block groups compared with the control group. 11 Although we found that the two blocks were comparable regarding our primary outcomes, the results of our secondary outcomes suggest that the two blocks do not act similarly.…”

“…[10][11][12] However, whether ESPB has similar analgesic effects to TPVB for breast surgery is still inconclusive. 11,13,14 Moreover, information on sensory blockade after ESPB is still mostly limited in case reports. [15][16][17] Injectate administered by ESPB is expected to make a wide spread in the craniocaudal direction, yet the results of cadaveric studies show inconsistent and unpredictable dye spread with little spread to the paravertebral space.…”