Clinical Efficacy of Erector Spinae Plane Block for Pain Management After Breast Surgeries: A Narrative Review

This narrative review explores the role of the erector spinae plane block (ESPB) as an alternative strategy for managing acute and chronic pain following breast surgeries. The focus is on its potential to reduce opioid consumption and the incidence of postmastectomy pain syndrome (PMPS), which remain significant postoperative concerns.

A structured literature search was conducted across PubMed, Google Scholar, Medline, and ScienceDirect using keywords including: Erector Spinae Plane Block, ESPB, postoperative analgesia, opioid reduction, breast surgery, mastectomy, and postmastectomy pain syndrome. Studies included randomized controlled trials, cohort studies, and case series published within the last 10 years. The quality of evidence was assessed based on study design, sample size, and reported outcomes.

ESPB has shown promise in reducing postoperative pain and opioid requirements in breast surgeries, including mastectomies, lumpectomies, reconstruction, and axillary dissections. By delivering local anesthetic into the fascial plane deep to the erector spinae muscle, ESPB provides multi-dermatomal analgesia with a favorable safety profile. Compared to other regional techniques such as pectoralis nerve blocks and paravertebral blocks, ESPB is often easier to perform and associated with comparable or improved analgesia. Some studies also report earlier ambulation and shorter hospital stays.

The ESPB has been shown to reduce the incidence of postmastectomy pain syndrome and opioid consumption following breast surgery. Current evidence indicates that both the ESPB and paravertebral blocks are both safe and effective in their analgesic purposes but there is no significant evidence favoring one block over the other.