Eman Abdulfattah Mohammed Ismael Mahmoud A. Kamel Somia Mohammed Abdel Aziz El Sheikh Mai M. Elrawas Ehab Hanafy Shaker Gendy

Keywords: Analgesia, Erector Spinae Plane Block, Modified Radical Mastectomy, Paravertebral Block, Pain, Postoperative Pain, Ultrasound

Abstract

Background & objectives: Mastectomy has been associated with moderate to severe postoperative pain, and radical mastectomy has always been cumbersome for the parients due to it being difficult to manage. During the recent past regional anesthesia techniques have gained popularity to be used alone or as a part of balanced anesthesia. We evaluated the safety and efficacy of ultrasound-guided erector spinae plane block (ESPB) in contrast to thoracic paravertebral block (TPVB) for postoperative analgesia following modified radical mastectomy (MRM).

Methodology: In this prospective, randomized, single-blind research, 44 women, scheduled for MRM, were enrolled. Patients were randomly assigned into two groups: Group TPVB recieved TPVB, and the second group received ESPB at the T5 level. Both blocks were performed prior to the induction of general anesthesia (GA) using 25 mL of 0.25 bupivacaine 0.25%, under aseptic conditions. Standard GA technique was used in both groups. Inj morphine IV was used as a rescue analgesic. Time to first analgesic, total analgesic dose and the number of patients requiring analgesia were noted.

Results: Both groups needed analgesia for a time that was comparable to one another. In the first twenty-four hours following the operation, between intraoperative fentanyl consumption, the number of cases requiring rescue morphine, total morphine consumption, pain VAS scores at rest, and movement did not show significant differences between the two groups. The hemodynamic variables remained comparable in both of the groups. Compared to TPVB group, the level of patient satisfaction was significantly higher with the ESPB group.

Conclusion: ESPB is an acceptable analgesic alternative to paravertebral block after MRM. ESPB is equally effective as TPVB in the duration of analgesia and postoperative pain and morphine usage during the first postoperative day.

Abbreviations: ESPB: Erector Spinae Plane Block, MRM: modified radical mastectomy, NCI: National Cancer Institute, TPVB: Thoracic Paravertebral Block, VAS: Visual Analogue Scale

Keywords: Analgesia; Erector Spinae Plane Block; Modified Radical Mastectomy; Paravertebral Block; Pain; Postoperative Pain; Ultrasound

Citation: Kamel MA, Ismael EAM, El Sheikh SMAZ, Elrawas MM, Gendy EHS. Ultrasound guided erector spinae plane block versus thoracic paravertebral block for perioperative analgesia for modified radical mastectomy: a randomized trial. Anaesth. pain intensive care 2025;29(4):292-300. DOI: 10.35975/apic.v29i4.2814

Received: January 27, 2025; Revised: May 01, 2025; Accepted: May 21, 2025