Modified Radical Mastectomy: Deep Versus Superficial Erector Spinae Block

Santosh  Kumar; Vikram  Nath; Rahul  Kumar

Authors

Santosh Kumar Senior Resident, Department of Anaesthesiology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India.
Vikram Nath Senior Resident, Department of Anaesthesiology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India
Rahul Kumar Associate Professor, Department of Anaesthesiology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India.

Keywords:

Opioid Consumption, Postoperative Pain, Erector Spinae Plane Block, Mastectomy

Abstract

Background- The quality of life, recovery, and functionality of patients are adversely affected by the intense pain that often follows breast cancer surgery, such as a modified radical mastectomy.

Objectives- This study was conducted to assess the effectiveness and safety of superficial and deep erector spinae plane (ESP) blocks in individuals undergoing modified radical mastectomy.

Materials and Methods- It was a randomized-controlled pilot study that was conducted at Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. The study was conducted for one year, i.e., from September 2023 to August 2024. The study comprised 50 female patients.

Results- The average age of the fifty female participants in the study was 52 years old. A consistent distribution of baseline clinical features and socioeconomic data was seen among the study groups. With a p-value < 0.05, the superficial ESP block group only lasted 04 hours before the first request for rescue analgesia, in contrast, the median length of 10 hours was significantly longer for the deep ESP block group.

Conclusion- This research shows that deep ESP blocks are more successful than superficial ESP blocks at lowering postoperative pain in patients having a modified radical mastectomy.

References

Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Regional Anesthesia & Pain Medicine. 2016 Sep 1;41(5):621-7.

Hamilton DL, Manickam B. Erector spinae plane block for pain relief in rib fractures. BJA: British Journal of Anaesthesia. 2017 Mar 1;118(3):474-5.

Chin KJ, Malhas L, Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery: a report of 3 cases. Regional Anesthesia & Pain Medicine. 2017 May 1;42(3):372-6.

Andersen KG, Kehlet H. Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention. The journal of Pain. 2011 Jul 1;12(7):725-46.

Malawat A, Jethava D, Sachdev S, Jethava DD. Erector spinae plane block for breast oncological procedure as a surrogate to general anaesthesia: A retrospective study. Indian Journal of Anaesthesia. 2020 Apr 1;64(4):328-33.

Nair AS, Seelam S, Naik V, Rayani BK. Opioid-free mastectomy in combination with ultrasound-guided erector spinae block: A series of five cases. Indian Journal of Anaesthesia. 2018 Aug 1;62(8):632-4.

Ueshima H, Otake H, Lin JA. Erector spinae plane block: a new implication for postoperative analgesia following thoracotomy. Anaesthesia. 2018;73(2): 123-5.

Schwartzmann A, Peng P, Maciel MA, Forero M. Mechanism of the erector spinae plane block: insights from a magnetic resonance imaging study. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2018 Oct;65:1165-6.

Tulgar S, Selvi O, Senturk O, Serifsoy TE, Thomas DT. Clinical experiences of erector spinae plane block for thoracic surgery: a retrospective study. J Thorac Dis. 2018;10(7):42 52-8.

Nielsen MV, Moriggl B, Hoermann R, Nielsen TD, Bendtsen TF, Børglum J. Ultrasoundguided erector spinae plane block for postoperative analgesia after thoracic surgery: a prospective cohort study. Anaesth Crit Care Pain Med. 2019;38(6):539-45.

Kot P, Rodriguez P, Granell M, Cano B, Rovira L, Morales J, Broseta A, De Andrés J. The erector spinae plane block: a narrative review. Korean journal of anesthesiology. 2019 Jun 1;72(3):209-20.

Singh S, Choudhary NK, Lalin D, Verma VK. Comparison of erector spinae plane block and thoracic epidural analgesia for postoperative pain relief in thoracic surgeries. Anaesth Pain Intens Care. 2019;23(3):311-6.

Solanki S, Mishra V. A study of peripheral nerve block for analgesia during caesarean section. Pain medicine. 2023;8(3-4):46-57.

Vidal E, Giménez H, Forero M, Fajardo M. Erector spinae plane block: a cadaver study to determine its mechanism of action. Revista Española de Anestesiología y Reanimación (English Edition). 2018 Nov 1;65(9):514-9.

High RA, Abdelmalak B, Abdel-Aziz M. The erector spinae plane block in breast surgery: a meta-analysis and trial sequential analysis. Pain Physician. 2019;22(5):E201-14.

Ventham NT, Hughes M, O'Neill S, Johns N, Brady RR, Wigmore SJ. Erector spinae plane block, the holy grail of analgesia for thoracotomy? Anaesthesia. 2019;74(7):915-8.

Jaramillo S, Bang S, Yang L, Nair J, Tsui B. The effect of erector spinae plane block on respiratory and analgesic outcomes in thoracic surgery: a systematic review. J Cardiothorac Vasc Anesth. 2019;33(6):1652-9.