Erector spinae plane block OR modified pectoralis block for postoperative analgesia after modified radical mastectomy: Which is better ???

Abstract

Finding the best analgesic technique for breast surgeries has always been a matter of great concern. Stable intraoperative hemodynamics and comfortable postoperative patient is what every anesthesiologist aspire of. The benefits of using regional blocks for postoperative analgesia is well known. Hence we intended to study the analgesic efficacy of two of the most latest blocks, used for breast surgeries, the PECS block and the ESP block. Materials and Methods:The prospective open label study was conducted in 59 ASA 1, 2 patients, planned for Modified Radical Mastectomy(MRM) under general anesthesia. After approval from institution scientific and research committee, and obtaining written informed consent, the patients were randomly divided into two groups(P and E). Group P(N=30), received ultrasound guided modified PEC block with 30ml of 0.25% levobupivacaine. Group E(N=29) received ultrasound guided ESP block with 30 ml of 0.25% levobupivacaine. General anesthesia was then administered in both the groups. The intraoperative hemodynamics, duration of analgesia, VAS score, number of rescue analgesia, patients satisfaction, safety and side effects were noted and compared between the two groups. Results: The mean VAS score at 24 hours was 4.11 ± 0.629 in group P and the mean VAS score at 24 hours post operatively was 3.69 ± 0.679 in group E, and the difference was statistically significant (P=0.024). Conclusion:Both PECS and ESP block can be used efficaciously for providing analgesia for MRM surgeries, with ESP block providing longer duration of pain free postoperative period, without any noted side effects and technical difficulties.