Efficacy of erector spinae plane block for postoperative analgesia in total mastectomy and axillary clearance: A randomized controlled trial

摘要

Background: The erector spinae plane block is a newer technique of analgesia to the chest wall. Objective: The study was carried out to establish the efficacy and safety of this block in patients undergoing total mastectomy and axillary clearance. Design: Prospective randomized controlled study. Setting: Single tertiary care center, the study was conducted over a period of 1 year. Patients: 65 patients were included; final analysis was done for 60 female patients undergoing total mastectomy and axillary clearance under general anesthesia were randomly allocated to two groups. Intervention: Group B (block group) received ultrasound-guided erector spinae plane block at T5 level with ropivacaine (0.5%, 0.4 mL/kg) while the control group did not receive any intervention. Postoperatively, patients in both groups received morphine via intravenous patient-controlled analgesia device. Patients were followed up for 24 h postoperatively. Main Outcome Measures: The 24-hour morphine consumption was considered as the primary outcome and secondary outcomes included time to first rescue analgesia, pain scores at 0, ?, 1, 2, 4, 6, 8, 12, and 24 h and characteristics and complications associated with block procedure. Results: The 24-hour morphine consumption was 42% lower in block group compared to control group [mean (SD), 2.9 (2.5) mg vs 5.0 (2.1) mg in group B and group C, respectively, P = 0.01]. The postoperative pain score was lower in group B vs group C at 0, 1/2, 1, 2, 4, 6, 12, and 24 h ( P 0.05). 26 patients in group C against 14 in group B used rescue analgesia within 1 h of surgery ( P = 0.01). Conclusion: Erector spinae block may prove to be a safe and reliable technique of analgesia for breast surgery. Further studies comparing this technique with other regional techniques are required to identify the most appropriate technique.