Ultrasound-guided erector spinae plane block compared to modified pectoral plane block for modified radical mastectomy operations

Gad, Mona; Abdelwahab, Khaled; Abdallah, Ahmed; Abdelkhalek, Mohamed; Abdelaziz, Mahmoud

doi:10.4103/aer.aer_77_19

Cited by 53 publications

(44 citation statements)

References 25 publications

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“…In the study of Gad et al, pain score and the frequency of analgesics use in the SEP group was higher than in the Pecs group, which was consistent with the results of the present study (16). A clinical trial by Ghamry and Amer (17) aimed at examining the role of erector spinae plane block (ESPB) versus paravertebral block in the control of postoperative pain after mastectomy showed no significant difference in pain score between the two groups within 24 hours (2,4,6).…”

Section: Discussionsupporting

confidence: 90%

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Pectoral Nerve Block and Erector Spinae Plane Block and Post-Breast Surgery Complications

et al. 2020

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Background: The use of regional methods in various types of surgery such as mastectomy is very popular today. Various methods, including Pecs I-II block, erector spinae, epidural thoracic, and paravertebral block have been used in these operations, each with its own advantages and disadvantages. Recent studies on the effect of µ receptor stimulation on the likelihood of recurrence and metastasis have been published, which make the use of a suitable regional approach with low complications and high efficacy attractive. Among the side effects of breast surgery in patients with cancer are nausea and vomiting, the risk of which is reduced through regional procedures that reduce the need for opioids. Methods: We randomly divided 64 patients into two pectoralis block (Pecs B) and erector spinae block (ESB) groups. Visual analogue scale (VAS) scores at 2, 4, 6, and 10 hours, nausea and vomiting, need for opioids, and hemodynamic changes were recorded. Results: The analyses showed that pain score was significantly higher in the Pecs B group compared to the ESB group, while VAS score, as well as the frequency of opioid use, were lower, which could be due to medial branch of the anterior intercostal nerve. Hemodynamic changes were also significantly greater in the ESB group, which could be due to the proximity of the block to the thoracic sympathetic nerves and spinal cord. Conclusions: Despite the statistically significant differences in analgesia and hemodynamic changes, the seemingly superiority of the Pecs B is not clinically significant and the use of both types of the block is selective. Regarding the need for opioids and nausea, Pecs B showed a tangible advantage over ESB.

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Section: Discussionsupporting

confidence: 90%

“…In a study by Altiparmak et al, the mean tramadol dose in the Pecs group was significantly lower than in the ESP group (20). In the study of Gad et al, morphine dose was significantly lower in the Pecs B group than in the ESPB group (16).…”

Section: Discussionmentioning

confidence: 93%

Pectoral Nerve Block and Erector Spinae Plane Block and Post-Breast Surgery Complications

et al. 2020

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“…Other outcomes reported in the trials comparing erector spinae plane block with pectoralis nerve block included: number of patients requiring postoperative analgesia; time to first rescue analgesia; incidence of injection pain; adverse complications of the blocks; stress hormone levels; and extent of sensory blockade. The number of patients requiring postoperative analgesia was reported in two studies [24, 27] and was significantly higher for the erector spinae plane block group (29 patients (65.9%)) than for pectoralis nerve group (15 patients (34.9%)). Time to first rescue analgesia was recorded by Sinha et al.…”

Section: Resultsmentioning

confidence: 99%

“…Gad et al. [27] measured levels of 'stress hormones' as an outcome and found that there were significant decreases in cortisol and prolactin levels at 1 h and 24 h postoperatively in the pectoralis nerve block group compared with the erector spinae plane block group. Sinha et al.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of erector spinae plane block for analgesia in breast surgery: a systematic review and meta‐analysis

et al. 2020

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Summary The erector spinae plane block is a new regional anaesthesia technique that provides truncal anaesthesia for breast surgery. This systematic review and meta‐analysis was undertaken to determine if the erector spinae plane block is effective at reducing pain scores and opioid consumption after breast surgery. This study also evaluated the outcomes of erector spinae plane blocks compared with other regional blocks. PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov were searched. We included randomised controlled trials reporting the use of the erector spinae plane block in adult breast surgery. Risk of bias was assessed with the revised Cochrane risk‐of‐bias tool. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to assess trial quality. Thirteen randomised controlled trials (861 patients; 418 erector spinae plane block, 215 no blocks, 228 other blocks) were included. Erector spinae plane block reduced postoperative pain compared with no block: at 0‐2 hours (mean difference (95% CI) −1.63 (−2.97 to −0.29), 6 studies, 329 patients, high‐quality evidence, I2 = 98%, p = 0.02); at 6 hours (mean difference (95% CI) −0.90 (−1.49 to −0.30), 5 studies, 250 patients, high‐quality evidence, I2 = 91%, p = 0.003); at 12 hours (mean difference (95% CI) −0.46 (−0.67 to −0.25), 5 studies, 250 patients, high‐quality evidence, I2 = 58%, p < 0.0001); and at 24 hours (mean difference (95% CI) −0.50 (−0.70 to −0.30), 6 studies, 329 patients, high‐quality evidence, I2 = 76%, p < 0.00001). Compared with no block, erector spinae plane block also showed significantly lower postoperative oral morphine equivalent requirements (mean difference (95% CI) −21.55mg (−32.57 to −10.52), 7 studies, 429 patients, high‐quality evidence, I2 = 99%, p = 0.0001). Separate analysis of studies comparing erector spinae plane block with pectoralis nerve block and paravertebral block showed that its analgesic efficacy was inferior to pectoralis nerve block and similar to paravertebral block. The incidence of pneumothorax was 2.6% in the paravertebral block group; there were no reports of complications of the other blocks. This review has shown that the erector spinae plane block is more effective at reducing postoperative opioid consumption and pain scores up to 24 hours compared with general anaesthesia alone. However, it was inferior to the pectoralis nerve block and its efficacy was similar to paravertebral block. Further evidence, preferably from properly blinded trials, is required to confirm these findings.

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“… 80 However, when ESPB was compared with a PECS block, all RCTs demonstrated that the latter led to significantly lower post-operative pain and opioid consumption compared with the former block. 41 , 45 , 52 Finally, only 1 RCT showed that increasing the concertation of bupivacaine from 0.25% to 0.375% led to a further decrease in pain and opioid consumption within the first 24 hours post-surgery.…”

Section: Resultsmentioning

confidence: 99%

Practical Review of Abdominal and Breast Regional Analgesia for Plastic Surgeons: Evidence and Techniques

ElHawary

Joshi

Janis

2020

Plastic and Reconstructive Surgery - Global Open

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Summary: Regional analgesia has been increasing in popularity due to its opioid- sparing analgesic effects and utility in multimodal analgesia strategies. Several regional techniques have been used in plastic surgery; however, there is a lack of consensus on the indications and the comparative efficacy of these blocks. The goal of this review is to provide evidence-based recommendations on the most relevant types of interfascial plane blocks for abdominal and breast surgery. A systematic search of the PUBMED, EMBASE, and Cochrane databases was performed to identify the evidence associated with the different interfascial plane blocks used in plastic surgery. The search included all studies from inception to March 2020. A total of 126 studies were included and used in the synthesis of the information presented in this review. There is strong evidence for using the transversus abdominis plane blocks in both abdominoplasties as well as abdominally-based microvascular breast reconstruction as evidenced by a significant reduction in post-operative pain and opioid consumption. Pectoralis (I and II), serratus anterior, and erector spinae plane blocks all provide good pain control in breast surgeries. Finally, the serratus anterior plane block can be used as primary block or an adjunct to the pectoralis blocks for a wider analgesia coverage of the breast. All the reviewed blocks are safe and easy to administer. Interfascial plane blocks are effective and safe modalities used to reduce pain and opioid consumption after abdominal and breast plastic surgery.

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Ultrasound-guided erector spinae plane block compared to modified pectoral plane block for modified radical mastectomy operations

Cited by 53 publications

References 25 publications

Pectoral Nerve Block and Erector Spinae Plane Block and Post-Breast Surgery Complications

Pectoral Nerve Block and Erector Spinae Plane Block and Post-Breast Surgery Complications

Efficacy of erector spinae plane block for analgesia in breast surgery: a systematic review and meta‐analysis

Practical Review of Abdominal and Breast Regional Analgesia for Plastic Surgeons: Evidence and Techniques

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