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

• Published in: Indian journal of anaesthesia Vol. 63; no. 12; pp. 1008 - 1014
• Main Authors: El Ghamry, Mona, Amer, Asmaa
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.12.2019; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Acute pain; Aircraft; Analgesia; Analgesics; Anesthesia; Blood pressure; Breast surgery; Bupivacaine; Cancer surgery; Cisatracurium; Consent; erector spinae plane block; Mastectomy; Medical research; modified radical mastectomy; Morphine; Narcotics; Original; Pain; Pain management; paravertebral block; Patients; post-operative pain; Postoperative pain; ultrasound; visual analogue scale; Women's health; paravertebral block; visual analogue scale; Erector spinae plane block; modified radical mastectomy; post-operative pain; ultrasound
• ISSN: 0019-5049; 0976-2817
• DOI: 10.4103/ija.IJA_310_19

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.