Ultrasound guided Erector Spinae Plane block versus thoracic epidural for post-mastectomy analgesia

Abstract

Background: Thoracic epidural analgesia (TEA) was considered as the gold standard for postoperative analgesia in thoracic surgeries, particularly in bilateral procedures. However, it isn't routinely used as it is associated with some haemodynamic side effects. Erector spinae plane (ESP) block is recognized as a promising post-operative analgesia technique. Aim of the study: Primary outcome was to compare post-mastectomy pain control in TEA and ESP block groups, and secondary outcomes were to compare post-operative hypotension, number of morphine boluses and patient satisfaction. Patients and Methods: Sixty female patients scheduled for elective mastectomy were enrolled in this study. Patients were allocated into 2 groups, 30 patients each. Group (TE) patients underwent ultrasound guided single shot TEA, while group (ES) were handled with ultrasound guided single shot ESP block. Peri-opertaive details, Post-operative hypotension, visual analogue scale (VAS) assessment of pain, number of post-operative morphine boluses, and patient satisfaction were recorded. Results: Time needed to give block was shorter in group (ES) (p < 0.001). Group (ES) patients reported significantly lower pain scores according to VAS (P<0.001). Hypotension was more recorded in group (TE) patients, with statistical significance at 0 point (p < 0.001). Required post-operative morphine boluses were significantly lower in group (ES), as 3.3% of patients received 3 boluses compared to 27% in group (TE) (p=0.01). More patients were highly satisfied in group ES (60%) than group TE (30%) (p=0.037). Conclusion: Ultrasound-guided ESP block is a choice with better outcome in patients undergoing elective mastectomy as regards lower frequency of hypotension, better efficiency and patient satisfaction.