By Ultrasonic-Guided Erector Spinae Block, Thoracic Paravertebral Block versus Serratus Anterior Plane Block by Articaine with Adrenaline during Breast Surgery with General Anesthesia: A Comparative Study of Analgesic Effect Post-Operatively: Double Blind Randomized, Controlled Trial

Abstract

Background and Aims: Erector spinae plane block, Paravertebral block and serratus anterior block are three formats for analgesia post-operatively following radical mastectomy. This study compares the analgesic efficacy of these modalities for analgesia post-operatively by articaine 2% with adrenaline. Methods: Seventy-five patients with ASA physical status I or II subjected to modified radical mastectomy with axillary clearance were enrolled for the study. After induction of general anaesthesia all patients received 20 mL 2% articaine with adrenaline in each technique of the study. Patients in Group 1 (Erector spinae block [ESB], n = 25), Group 2 paravertebral block [PVB] n = 25), Group 3 (serratus anterior plane block [SAPB] n = 25) were ultrasound-guided on ipsilateral side. Patients were estimated for pain scores at 0, 2, 4, 6, 12 and 24 h, and duration of analgesia post-operatively and relieve analgesic doses required of morphine up to 24 h. Results: Visual analogue scale scores post-operatively were lower in ESB and PVB group compared with SAPB at 4, 6, 12 and 24 h (P < 0.05). The first analgesic dose requirement was significantly longer in ESB (416 ± 68 min) than PVB group (371 ± 67 min) in compared with SAPB (343.5 ± 54.7 min). Mean duration of analgesia was significantly longer in ESB and PVB group (P < 0.001) in compared with SAPB. Total morphine dose of relieving analgesic was significantly lesser in ESB (4 ± 2 mg) than PVB group (6 ± 2 mg) compared with SAPB

Erector Spinae Plane Block Similar to Paravertebral Block for Perioperative Pain Control in Breast Surgery: A Meta-Analysis Study

“…Existing evidence has suggested modest effectiveness of ESPB when compared with systemic analgesics alone in breast surgery (12)(13)(14)(15)(16)(17)(18)(19), whereas controversial results have been reported when compared with PVB (13,(20)(21)(22). Previous systematic reviews and metaanalyses reported the efficacy of ESPB in some specific surgery (23)(24)(25)(26), but trials of surgeries other than breast surgery were included in these meta-analyses.…”

“…The characteristics of the included studies are presented in Table 1. Surgical procedures performed in these studies included mammoplasty (22), modified radical mastectomy (12)(13)(14)(15)(16)(17)(18)(19)(20)(21), simple mastectomy, and lumpectomy (12)(13)(14)22) with or without additional axillary sentinel lymph nodes dissection (12)(13)(14)21). The 11 randomized control trials involved 837 patients, of which 392 received ESPB before surgery, 133 received PVBs, and the remaining 235 received general anesthe-sia alone (control group).…”

“…The 11 randomized control trials involved 837 patients, of which 392 received ESPB before surgery, 133 received PVBs, and the remaining 235 received general anesthe-sia alone (control group). Of these 11 studies, 8 compared ESPB with general anesthesia alone (12)(13)(14)(15)(16)(17)(18)(19)) and 4 with PVB (13,(20)(21)(22) The included patients were all ASA I or II, and none of them had chronic pain, long-term opioid use, secondary surgery, or contraindication to regional analgesia.…”

“…Opioid-related side effects such as postoperative nausea and vomiting (PONV) were reported in 10 studies (12)(13)(14)(15)(16)(17)(18)20,22). Complications of regional analgesics were reported in 7 studies, and only 4 cases with pneumothorax were recorded in the PVB group (12,14,16,17,21). Two studies mentioned the time in the PACU and the time to hospital discharge (17,22), and only 2 studies reported patients' satisfaction (16,17).…”

Statistically significant but clinically unimportant: a systematic review and meta-analysis of the analgesic benefits of erector spinae plane block following breast cancer surgery

“…4 However, much of the reviews evaluating ESPB in breast surgery are qualitative in nature 5 and limited by pooling breast surgery together with thoracic procedures; 6 while the most recent investigation conducted multiple comparisons to other truncal blocks and provided statistical conclusions devoid of clinical interpretations. 7 As for individual randomized clinical trials, the results have been decidedly mixed [8][9][10] and difficult to interpret, primarily because they involved comparisons to various other blocks. 8 11 12 In order to definitively address the analgesic efficacy of ESPB for breast cancer surgery, we aimed to compare the analgesic effects of ESPB to parenteral analgesia alone.…”