Erector spinae plane block versus local anaesthesia instillation via the surgical drain in mastectomy patients at a tertiary institution

Neo Motaung; Kenalemodisa  Mogotsi; Mathabe  Sehlapelo

doi:10.51168/sjhrafrica.v7i2.2672

Authors

Dr. Neo Motaung MBChB, DA (SA), Department of Anaesthesiology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Dr. Kenalemodisa Mogotsi MBChB, DA (SA), FCA (SA), MMed (Anaes) (Wits), Department of Intensive Care Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Dr. Mathabe Sehlapelo MBChB, DA(SA), FCA (SA), MMed (Anaes) (Wits), DTM&H (Wits), DipHivMan (SA), Higher Cert HSM (Regent), PG Dip HSE (Wits), Department of Anaesthesiology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2672

Keywords:

Erector spinae plane block, mastectomy, postoperative analgesia, local anaesthesia

Abstract

Background: Analgesic strategies for breast cancer surgeries continue to evolve, with the focus on reducing reliance on opioids and improving recovery. The erector spinae plane block (ESPB) and local anaesthesia (LA) instillation via the surgical drain represent two distinct approaches. The primary objective was to compare postoperative pain scores using the universal pain assessment tool (UPAT) between the two groups at 6 and 24 hours.

Methods: A prospective observational cohort study was conducted in 66 female patients, aged over 18 years, classified ASA I-III and scheduled for elective unilateral mastectomy. Using purposive sampling, participants were allocated into Group E (n=33), who received ESPB with 20 ml of 0.5% bupivacaine with adrenaline before induction. In comparison, Group L (n=33) received postoperative instillation of 20 ml of 0.5% bupivacaine via the surgical drain.

Results: Group E had significantly lower postoperative pain scores at 6 hours, median (1 vs 3, p=0.013) and 24 hours, median (1 vs 3, p<0.001), with a medium to large effect size at 24 hours. Group E required significantly less intraoperative morphine, median (3 mg vs 6 mg), p<0.001, experiencing longer time to first opioid request, median (10.4 vs 8.1 hours, p=0.03) and required less postoperative intravenous tramadol (p=0.01). There was no significant difference in the intraoperative analgesia and adjuvant requirements. The patients and surgical characteristics were comparable between the groups. No complications were reported in either group, and Group E showed higher patient satisfaction compared to Group L.

Conclusion: The ESPB provided more effective and superior postoperative analgesia than LA instillation via the surgical drain, as evidenced by the significantly lower pain scores and perioperative opioid consumption.

Recommendations: The authors recommend a randomised control trial comparing ESPB, TPVB and PEC with a large sample size, and presentation of research to breast surgeons to emphasise a paradigm shift.

Author Biographies

Dr. Neo Motaung, MBChB, DA (SA), Department of Anaesthesiology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.

is a third-year medical registrar in the Department of Anaesthesiology at the University of Witwatersrand. This research was conducted in partial fulfilment of the requirements for her Master of Medicine degree in the branch of Anaesthesiology. She completed her undergraduate medical studies at the University of Limpopo (Medunsa) and graduated in 2014. She holds a Diploma in Anaesthesiology (2019). She is currently a registrar completing rotations that form part of the clinical requirements within the WITS circuit, with Chris Hani Baragwanath Academic Hospital being her base hospital in Johannesburg, Gauteng.

Dr. Kenalemodisa Mogotsi, MBChB, DA (SA), FCA (SA), MMed (Anaes) (Wits), Department of Intensive Care Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.

is a certified specialist Anaesthesiologist and lecturer, currently in pursuit of a fellowship in Critical Care at the University of Witwatersrand, Chris Hani Baragwanath Academic Hospital Intensive Care Unit. She completed her undergraduate medical degree at the University of Pretoria, and she holds a Diploma in Anaesthesiology, a Fellowship of the College of Anaesthesiology of South Africa (FCA) (SA) through the College of Medicine of South Africa. Furthermore, she obtained her MMed from the University of Witwatersrand.

Dr. Mathabe Sehlapelo, MBChB, DA(SA), FCA (SA), MMed (Anaes) (Wits), DTM&H (Wits), DipHivMan (SA), Higher Cert HSM (Regent), PG Dip HSE (Wits), Department of Anaesthesiology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.

is a senior anaesthesiologist at Chris Hani Baragwanath Academic Hospital and lecturer in the Department of Anaesthesiology, University of Witwatersrand, Johannesburg, South Africa. She is the domain head of airway management, breast, and endocrine. She is committed to health system sciences education through innovative pedagogy, student mentorship, health system management, and community engagement.

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