Erector spinae plane block versus paravertebral block for major oncological breast surgery: a multicentre randomised controlled trial

Abstract

Background: Breast cancer is the most common cancer in women, and oncological breast surgery often results in significant postoperative pain. Regional analgesia techniques such as thoracic paravertebral block (PVB) are effective but carry risks, whereas the erector spinae plane block (ESPB) is a newer, potentially safer alternative. We compared the efficacy of ESPB and PVB for managing acute pain after major breast cancer surgery.

Methods: This prospective, multicentre, randomised, double-blind trial involved 292 women who underwent major breast surgery. Patients were randomised to receive either ESPB or PVB. The primary outcome was the percentage of participants requiring morphine within the first 2 h after surgery, and the secondary outcomes included pain scores, morphine consumption, complications, and participants satisfaction.

Results: A total of 75.2% and 50.3% of the participants in the ESPB and PVB groups, respectively, required morphine, and the noninferiority criterion for ESPB was not met. However, morphine consumption was similar between the groups. Pain scores were greater in the ESPB group, especially during mobilisation, and ESPB provided less reliable dermatomal coverage than PVB, with the required area was not covered in 55.9% of participants in the ESPB group compared with 20.4% of participants in the PVB group. Satisfaction was similar between groups, with participants in both groups reporting high satisfaction. No major complications were observed.

Conclusions: Compared with thoracic paravertebral block, erector spinae plane block did not meet the noninferiority criteria and was less effective for complete analgesia. Thoracic paravertebral block remains the preferred technique for major breast surgery.

Clinical trial registration: ClinicalTrials.gov (NCT04827030).

Keywords: breast surgery; erector spinae plane block; mastectomy; oncology; paravertebral block; postoperative pain.