Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study

Abstract

Background Although case reports have suggested that the erector spinae plane block (ESPB) may help analgesia for patients after breast surgery, no study to date has assessed its effectiveness. This retrospective observational study analyzed the analgesic effects of the ESPB after total mastectomy. Methods Forty-eight patients were divided into an ESPB group (n = 20) and a control group (n = 28). Twenty patients in the control group were selected by their propensity score matching the twenty patients in the ESPB group. Patients in the ESPB group were injected with 30 mL 0.375% ropivacaine, followed by catheter insertion for further injections of local anesthetics every 12 hours. Primarily, total fentanyl consumption was compared between the two groups during the first 24 hours postoperatively. Secondary outcomes included pain intensity levels (visual analogue scale) and incidence of postoperative nausea and vomiting (PONV). Results Median cumulative fentanyl consumption during the first 24 hours was significantly lower in the ESPB (33.0 μg; interquartile range [IQR], 27.0–69.5 μg) than in the control group (92.8 μg; IQR, 40.0–155.0 μg) ( P = 0.004). Pain level in the early postoperative stage (<3 hr) and incidence of PONV (0% vs . 55%) were also significantly lower in the ESPB group compared to the control ( P = 0.001). Conclusions Intermittent ESPB after total mastectomy reduces fentanyl consumption and early postoperative pain. ESPB is a good option for multimodal analgesia after breast surgery.

The analgesic efficacy of a single injection of ultrasound-guided retrolaminar paravertebral block for breast surgery: a prospective, randomized, double-blinded study

“…Therefore, to maximize the effect of RLB and to effectively control postoperative pain, we suggest that this block should be performed at the end of the surgery. Considering a recent study on the erector spinae plane block, which is similar to the RLB [29], the continuous infusion method in the RLB could be a good option for adequate postoperative analgesia following breast surgery.…”

The efficacy of ultrasound-guided erector spinae plane block after mastectomy and immediate breast reconstruction with a tissue expander: a randomized clinical trial

“…However, there is conflicting opinion as to whether this block may be effective in managing postoperative pain. Several clinical studies have shown that the ESPB may be effective in postoperative pain control for various types of thoraco-abdominal surgery [ 7 - 11 ], while, there have been some contrary results suggesting that the ESPB has a limited effect on postoperative pain control [ 12 - 14 ].…”

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

“…Post-mastectomy analgesia consists of many regional techniques. [1] Paravertebral block (PVB) is the most effective studied technique, but due to its anatomic proximity to pleura and central neuroaxial system, it is a challenging one. [2] Erector spinae plane block (ESPB) has been used successfully for post-operative analgesia in breast surgeries.…”