Comparative study between the analgesic effect of erector spinae plane block and thoracic paravertebral block in patients undergoing modified radical mastectomy

Abstract

Background: Various pain relief choices are available for breast surgeries, comprising opioids, and nerve blocks like pectoralis block, serratus block, thoracic paravertebral block (PVB), and erector spinae plain block. Objectives: The current investigation evaluated the pain-relieving effects of erector spinae plane block (ESPB) compared to thoracic PVB in patients who underwent modified radical mastectomy. Methods: Participants ranged in age from 18 to 70 years and were part of a prospective, randomized, double-blind trial, those whose BMI is between the range of 18.5 to 29.9and classified as American Society of Anesthesiologists (ASA) class I-II, who were undergoing modified radical mastectomy. Participants differed into two equal groups: Group A got unilateral ultrasound-guided PVB by 0.25% Bupivacaine 30 ml, while Group B got unilateral ESPB by 0.25% Bupivacaine 30 ml under ultrasound guidance. Mean arterial pressure (MAP) and heart rate (HR) measurements were taken upon patient arrival as baseline, after 10 minutes of performing the block, and subsequently after the skin incision several periods throughout the operation. Additionally, intraoperative consumption of Fentanyl was noted. Visual Analogue Scale (VAS) was used to assess the pain severity by 15 minutes after admission to the recovery room, and subsequently at regular intervals for up to 24 hours post-admission. Results: No significant differences were found between the two groups regarding intraoperative MAP, HR, fentanyl requirement, VAS scores, or pethidine usage metrics (time of first use, requirement, number of patients, total usage) and complication incidence (p > 0.05 for all). Conclusions: ESPB under the guidance of ultrasound shows similar effectiveness to PVB under the guidance of ultrasound for modified radical mastectomy. No significant differences were observed in intraoperative MAP, HR, fentanyl use, VAS scores post-operation, time to 1st rescue analgesia, or pethidine consumption amongst both techniques.