Ultrasound-Guided Erector Spinae Plane Block Compared to Modified Pectoral Plane Block for Modified Radical Mastectomy Operations

Mona Gad, Khaled Abdelwahab, Ahmed Abdallah, Mohamed Abdelkhalek, Mahmoud Abdelaziz, Mona Gad, Khaled Abdelwahab, Ahmed Abdallah, Mohamed Abdelkhalek, Mahmoud Abdelaziz

Abstract

Background: Modified radical mastectomy (MRM) is the most common surgery for cancer breast that is associated with marked postoperative pain. Effective control of this pain suppresses the surgical stress response and decreases the opioids and general anesthetics' needs. This study compared the erector spinae plane (ESP) block and the pectoral plane (PECS) block effects on the opioid consumption postoperatively, stress response, fentanyl needs intraoperatively, pain scores, and incidence of complications in female patients subjected to MRM surgery.

Patients and methods: Fifty patients were allocated randomly and divided into two groups. Forty-seven patients were included in the final analysis after exclusion. ESP block group (E group, n = 24) received 20 mL of 0.25% levobupivacaine plus 0.5 μ/kg dexmedetomidine that was injected in-between erector spinae muscle and transverse process. PECS block group (P group, n = 23) received 30 mL of 0.25% levobupivacaine plus 0.5 μg/kg dexmedetomidine divided into 10 mL that was injected between the two pectoralis muscles in the interfascial plane and the other was 20 mL injected between the serratus anterior and the pectoralis minor.

Results: Postoperative morphine consumption and stress hormone level in P group were significantly lower than E group. The pain scores and number of patients requested analgesic postoperatively showed significantly higher values in E group. Hemodynamic parameters, fentanyl needed intraoperatively and the incidence of postoperative complications recorded no significant difference between the two groups.

Conclusion: The current study demonstrated that PECS block provides better quality of analgesia than ESP block in patients subjected to MRM operations.

Keywords: Cancer breast; erector spinae plane block; pectoral nerve block; stress response.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
The flow diagram of patient progress through the randomized trial
Figure 2
Figure 2
The cortisol levels of the studied groups (μg/dL). Data are in mean ± standard deviation. E = ESP. P = PECS. P<0.05 is significant. *Significant for P in comparison to E, #Significant at 1 h, 24 h postoperative in comparison with basal in the same group. ESP = Erector spinae plane, PECS=Pectoral plane block
Figure 3
Figure 3
The prolactin levels of the studied groups (ng/mL) data are in mean ± standard deviation. E = ESP, P = PECS. P<0.05 is significant. *Significant for P in comparison to E, #Significant at 1 h, 24 h postoperative in comparison with basal in same group. ESP = Erector spinae plane, PECS=Pectoral plane block

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Source: PubMed

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