Analgesic Efficacy Comparison Between Ultrasound-Guided Erector Spinae Plane Block and Retrolaminar Block in Patients...

Breast cancer is the most common cancer in females. Surgery is the gold standard therapy, with modified radical mastectomy (MRM) being the most commonly performed procedure for breast cancer. Management of postoperative pain after MRM poses a clinical challenge and hence receives utmost priority. Ultrasound-guided regional nerve blocks are commonly administered to combat post-surgical pain after MRM. In this context, retrolaminar block (RLB) and erector spinae plane block (ESPB) are relatively newer techniques. Though these blocks are quicker, safer, and easier to administer, very few studies have been done to compare their postoperative analgesic efficacy. Henceforth, we conducted this trial to compare the postoperative analgesic efficacy of ESPB and RLB in patients scheduled for MRM.

The procedures followed in this trial were according to the norms of the Declaration of Helsinki (2013). The study was started after obtaining approval from the Institutional Ethics Committee (IEC), written informed consent from the patients, and trial registration in the Clinical Trials Registry of India. Sixty female patients of the American Society of Anesthesiologists with physical statuses 1, 2, and 3, aged 18 years and above, planned for unilateral MRM under general anesthesia, were included, whereas patients not giving consent, allergic to study drugs, having contraindications to regional anesthesia, with a body mass index (BMI) of ≥ 35 kg/m², deformity of the spine, psychiatric illness, lactating, or pregnant women were excluded. Computer-generated randomization was used to allocate the patients to groups E and R to receive ESPB or RLB, respectively, using 30 mL of ropivacaine (0.5%) with 2 mL of dexamethasone at the T4 spinous process level under ultrasound guidance. The primary outcome was to determine the time to rescue analgesia based on a visual analog scale score ≥ 4. Secondary objectives were the intraoperative fentanyl consumption and side effects (if any).

Sixty participants completed the study. Both groups were comparable in terms of demographic parameters, duration of surgery, time to the first dose of rescue analgesia, intraoperative fentanyl consumption, and side effects. The mean (SD) of duration of surgery (minutes) was 202.33 (14.55) and 197.00 (18.60) with P = 0.134, time to rescue analgesia (minutes) was 425.67 (134.33) and 468.50 (142.74) with P = 0.236, and intraoperative fentanyl consumption (mcg) was 4.00 (11.02) and 4.67 (8.60) with P = 0.410 in Group E and R, respectively.

Both groups were similar in terms of the time to rescue analgesia, fentanyl consumption intraoperatively, and side effects. Thus, the ESPB is comparable to and not better than RLB for providing postoperative analgesia in patients with carcinoma breast undergoing MRM.