A Randomized Clinical Study to Compare the Perioperative Analgesic Efficacy of Ultrasound-Guided Erector Spinae Plane Block Over Thoracic Epidural in Modified Radical Mastectomy.

Abstract

Aim This study aims to compare the effectivenessof ultrasound-guided erector spinaeblock (ESB) with thoracic epidural (TE) in managing postoperative pain amongbreast cancer (BC) surgery patients. Methods A total of 42 patients wereenrolled and randomly divided into two groups, each comprising 21 participants. Primary endpoints assessed included intraoperative fentanyl consumption, postoperative pain scores,andthe need forrescue analgesia.Secondary endpoints encompassed intraoperative hemodynamic changesand theincidence of postoperative nausea and vomiting (PONV). Results Thestudy foundno significant difference inintraoperative fentanyl requirement (p=0.62) or postoperative pain scores measured using numerical rating scores (NRS)throughout the 48-hourpostoperative period. None of the patients in eithergrouprequired rescue analgesia.Notably, there was a statistically significant difference in postoperative nausea and vomitingat the two-hour mark, favoringthe erector spinae block. Both groups exhibited comparablehemodynamic changes during intraoperative monitoring. Conclusions Ourinvestigation concludes that theESF offersequivalentanalgesic efficacy to the thoracic epidural duringbothsurgery and thepostoperativeperiod withoutinducing any significant hemodynamic instability. Consideringthe lower complicationrate associated withparaspinal blocks compared to neuraxial blocks,the ESB presents itself as a promising alternative method for effectivepain reliefinmastectomy procedures.