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. 2020 Apr-Jun;14(2):186-191.
doi: 10.4103/sja.SJA_625_19. Epub 2020 Mar 5.

Efficacy of erector spinae plane block for postoperative analgesia in total mastectomy and axillary clearance: A randomized controlled trial

Shashikant Sharma  1 , Suman Arora  1 , Anudeep Jafra  1 , Gurpreet Singh  2
Affiliations

Efficacy of erector spinae plane block for postoperative analgesia in total mastectomy and axillary clearance: A randomized controlled trial

Shashikant Sharma et al. Saudi J Anaesth. 2020 Apr-Jun.

Abstract

Background: The erector spinae plane block is a newer technique of analgesia to the chest wall.

Objective: The study was carried out to establish the efficacy and safety of this block in patients undergoing total mastectomy and axillary clearance.

Design: Prospective randomized controlled study.

Setting: Single tertiary care center, the study was conducted over a period of 1 year.

Patients: 65 patients were included; final analysis was done for 60 female patients undergoing total mastectomy and axillary clearance under general anesthesia were randomly allocated to two groups.

Intervention: Group B (block group) received ultrasound-guided erector spinae plane block at T5 level with ropivacaine (0.5%, 0.4 mL/kg) while the control group did not receive any intervention. Postoperatively, patients in both groups received morphine via intravenous patient-controlled analgesia device. Patients were followed up for 24 h postoperatively.

Main outcome measures: The 24-hour morphine consumption was considered as the primary outcome and secondary outcomes included time to first rescue analgesia, pain scores at 0, ½, 1, 2, 4, 6, 8, 12, and 24 h and characteristics and complications associated with block procedure.

Results: The 24-hour morphine consumption was 42% lower in block group compared to control group [mean (SD), 2.9 (2.5) mg vs 5.0 (2.1) mg in group B and group C, respectively, P = 0.01]. The postoperative pain score was lower in group B vs group C at 0, 1/2, 1, 2, 4, 6, 12, and 24 h (P < 0.05). 26 patients in group C against 14 in group B used rescue analgesia within 1 h of surgery (P = 0.01).

Conclusion: Erector spinae block may prove to be a safe and reliable technique of analgesia for breast surgery. Further studies comparing this technique with other regional techniques are required to identify the most appropriate technique.

Keywords: Acute postoperative pain; analgesia; breast surgery; erector spinae plane block; pain score; patient-controlled; regional anesthesia; ropivacaine; total mastectomy and axillary clearance; ultrasound-guided.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Consort diagram
Figure 2
Figure 2
Dermatomal spread in the Erector spinae block group
See this image and copyright information in PMC

References

    1. Carpenter JS, Andrykowski MA, Sloan P, Cunningham L, Cordova MJ, Studts JL, et al. Postmastectomy/post lumpectomy pain in breast cancer survivors. J Clin Epidemiol. 1998;51:1285–92. - PubMed
    1. Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, et al. Risk factors for chronic pain following breast cancer surgery: A prospective study. J Pain. 2006;7:626–34. - PMC - PubMed
    1. Cheng GS, Ilfeld BM. A review of postoperative analgesia for breast cancer surgery. Pain Manag. 2016;6:603–18. - PubMed
    1. Vila H, Liu J, Kavasmaneck D. Paravertebral block: New benefits from an old procedure. Curr Opin Anaesthesiol. 2007;20:316–8. - PubMed
    1. Chakraborty A, Khemka R, Datta T, Mitra S. COMBIPECS, the single-injection technique of pectoral nerve blocks 1 and 2: A case series. J Clin Anesth. 2016;35:365–8. - PubMed