Deep versus superficial erector spinae block for modified radical mastectomy: A randomised controlled pilot study

Area of Science:

• Anesthesiology
• Regional Anesthesia
• Pain Management

Background:

• Erector spinae (ES) plane block has two described techniques: superficial and deep to the ES muscle.
• The superficial technique may result in suboptimal analgesia due to an additional muscle layer.
• Modified radical mastectomy (MRM) is a surgical procedure requiring effective postoperative pain management.

Purpose of the Study:

• To compare the efficacy of superficial versus deep ES plane block techniques.
• To evaluate analgesia and sensory blockade in patients undergoing MRM.
• To determine the optimal ES plane block approach for breast surgery pain control.

Main Methods:

• Prospective study involving 40 ASA I/II female patients aged 18-60 undergoing unilateral MRM.
• Group D received 20 mL 0.2% ropivacaine deep to the ES muscle at T4.
• Group S received 20 mL 0.2% ropivacaine superficial to the ES muscle.
• Evaluated sensory block level, perioperative opioid consumption, and adverse effects.

Main Results:

• Twenty-four-hour morphine consumption was significantly lower in the deep ES group (5.47 ± 1.1 mg) compared to the superficial group (7.66 ± 0.74 mg) (P < 0.001).
• The deep ES block resulted in greater cranio-caudal sensory spread along the posterior and mid-axillary lines.
• No adverse effects were reported in either group.

Conclusions:

• The deep ES plane block technique offers superior analgesia and more extensive sensory blockade for the chest wall.
• This technique is recommended for better pain management following breast surgery.
• The superficial ES plane block technique provides inferior analgesia compared to the deep approach.