Analgesic efficacy, immunomodulation and complications of Erector spinae plane block in breast cancer surgeries: A randomized controlled trial

Abstract

Background To investigate the effect and drawbacks of different LA volumes and concentrations of ESPB on postoperative need for opioids and rescue analgesics, post-mastectomy acute neuropathic pain, and NK cells cytotoxicity.Methods 60 breast cancer patients, ranging in age from 18 to 70 and with an ASA I–II, were randomly assigned to receive ESPB with 20 ml 0.25% bupivacaine (Standard volume ESPB), 40 ml 0.125% bupivacaine (High volume ESPB), or no ESPB (GA only group) after being scheduled for surgery. The primary outcome was total morphine administered over the first 24 postoperative hours. The secondary endpoints were amount of rescue analgesia needed, acute neuropathic pain assessed by DN4 questionnaire, NKC cytotoxicity and complications.Results Total amount of morphine consumed was less in both ESPB groups compared with the control (1.13 ± 1.77 vs. 1.35 ± 3.15 vs. 9.58 ± 5.76, p < 0.001).Ketorolac was less needed, as postoperative rescue analgesic, in both ESPB groups compared with the GA group Similar incidence of acute postoperative neuropathic pain was observed . NKC cytotoxicity did not differ among the three studied groups; however, the high volume of LA enhanced the postoperative cytotoxicity relative to the preoperative one. No complications of the block had been recorded and the incidence of PONV is less in ESPB groups than the control .Conclusions ESPB is an effective and safe analgesic modality as it attenuates the postoperative need for opioids and rescue analgesics, when bupivacaine is used in a dose of 50 mg with variable volumes and concentrations. It does not alter the incidence of acute post-mastectomy neuropathic pain; nevertheless, it delays its onset and mitigates its severity. Its role in enhancing the NK cells cytotoxicity needs further evaluation.Trial registration NCT04796363Date of registration March 12, 2021

Keywords

• Erector spinae plane block
• Ultrasound guided
• analgesia
• NK cells
• immunomodulation and Breast cancer surgery