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. 2021 Apr-Jun;15(2):137-143.
doi: 10.4103/sja.sja_990_20. Epub 2021 Apr 1.

The comparison of the efficacy of ultrasound-guided paravertebral block versus erector spinae plane block for postoperative analgesia in modified radical mastectomy: A randomized controlled trial

Shilpi Agarwal  1 , Sachidanand Jee Bharati  1 , Sushma Bhatnagar  1 , Seema Mishra  1 , Rakesh Garg  1 , Nishkarsh Gupta  1 , Vinod Kumar  1 , Maroof Ahmad Khan  2
Affiliations

The comparison of the efficacy of ultrasound-guided paravertebral block versus erector spinae plane block for postoperative analgesia in modified radical mastectomy: A randomized controlled trial

Shilpi Agarwal et al. Saudi J Anaesth. 2021 Apr-Jun.

Abstract

Introduction: The ultrasound (US)-guided erector spinae plane (ESP) block is a new regional anesthetic technique that offers significant advantages over paravertebral block as it is easy and safe to perform. We aim to compare the efficacy of US-guided paravertebral block with ESP block for postoperative analgesia in modified radical mastectomy (MRM).

Methods: Eighty female patients of age group 18-70 years, belonging to physical status American Society of Anesthesiologists (ASA) I and II, undergoing MRM were included in the study. In Group P, patients received paravertebral block and in Group E, patients received ESP block before induction of general anesthesia. Both the groups received 0.5% 20 mL ropivacaine. The time to first rescue analgesia and total doses of rescue analgesics were recorded in the postoperative period. Numeric Rating Scale (NRS) scores at 0 min, 30 min, 1 h, 2 h, 6 h, 12 h, and 24 h were noted, and patient satisfaction was evaluated at 24 h. Unpaired t-test or the Mann-Whitney U test was used to compare quantitative variables while Chi-square test or Fisher's exact test was used to compare qualitative variables.

Results: The time for the first analgesic request was 232.5 min (140-1200) in ESP group as compared to paravertebral group in which the duration was 205 min (135-1190) (P value = 0.29). The total dose of rescue analgesics and NRS scores in postoperative period were comparable. However, the time to perform ESP block was significantly shorter than that of paravertebral block.

Conclusion: ESP block can be used as a safe and easy to perform alternative analgesic technique over paravertebral block in breast cancer surgeries.

Keywords: Erector spinae plane block; modified radical mastectomy; paravertebral block.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Image depicting the procedure of paravertebral block. TP (Transverse Process). Arrows show the path of the needle towards the paravertebral space (a). The pleura is deflected downwards when the drug is deposited in paravertebral space (b)
Figure 2
Figure 2
Image depicting the procedure of ESPblock. TP (Transverse Process), TM (Trapezius), RM (Rhomboid Major), ESM (Erector Spinae Muscle). The arrow shows the tip of the needle at the T5 transverse process (a) The erector spinae muscle is lifted off the transverse process when the drug is deposited deep into the muscle (b)
Figure 3
Figure 3
CONSORT Diagram
Figure 4
Figure 4
Box Plot showing the duration of analgesia
Figure 5
Figure 5
Box Plot showing the Numeric Rating Scale (NRS) scores at rest and at movement at different time points
See this image and copyright information in PMC

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