Combined erector spinae and pecto-intercostal plane blocks versus thoracic paravertebral block in patients scheduled for modified radical mastectomy: A randomized controlled trial

Abstract

Background: We aimed to compare the perioperative analgesic efficacy of combined erector spinae and pecto-intercostal (ES-PI) plane blocks versus thoracic paravertebral block (PVB) in patients undergoing modified radical mastectomy (MRM). Materials and Methods: This randomized controlled trial included women scheduled for unilateral MRM under general anesthesia. The participants were randomized to receive ES-PI plane or thoracic PVB. All patients received paracetamol 1 g/8 h postoperatively. Rescue analgesia was 75 mg of diclofenac, if it was inadequate, 2 mg boluses of morphine were given. The primary outcome was the time to first rescue analgesia in the first 48 h postoperatively. Secondary outcomes included Numerical Rating Score (NRS), postoperative rescue analgesic requirement, and intraoperative hemodynamic parameters. We also recorded hypotension, bradycardia, nausea, vomiting, and pain at the injection site. Results: Thirty patients were analyzed. The time to first rescue analgesia was comparable between the two groups (median [interquartile range]: 20 [16, 21] h vs. 5 [4, 6] h, P = 0.102). The postoperative static and dynamic NRS (P < 0.001) and rescue analgesic requirements (P = 0.015) were higher in the ES-PI group than in the PVB groups. The intraoperative fentanyl requirements were comparable in both groups (P = 0.367), as well as the hemodynamic changes. The observed complications between the two groups were also comparable. Conclusion: In women undergoing unilateral MRM, thoracic PVB provided superior analgesia to ESPB despite the latter supplementation with pecto-intercostal plane block.

Keywords

• erector spinae plane block
• modified radical mastectomy
• pecto-intercostal plane block
• thoracic paravertebral block