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.

Keywords: Erector spinae plane block; modified radical mastectomy; paravertebral block; post-operative pain; ultrasound; visual analogue scale.

Figure 1

CONSORT flow diagram

Figure 2

Sonoanatomy at the level of the fifth thoracic vertebrawith shadow of the needle advanced towards the transverse process and local anaesthetic injection between the tip of transverse process and the fascia of erector spinae muscle. (In this patient with thick adipose tissue at the site of the block, the curved probe was used) TP = Transverse process, ESM = Erector spinae muscle, LA = Local anaesthetic

Figure 3

Visual analogue scale in two groups. Data presented as median (inter-quartile range)

Figure 4

Heart rate (beat/min) and mean blood pressure (mmHg) changes in two groups. Data presented as mean ± standard deviation