Efficacy of Erector Spinae Plane Block with Opioid-sparing Analgesic Technique in Breast-conserving Surgery

Overview

Journal Ann Surg Treat Res

Specialty General Surgery

Date 2021 May 20

PMID 34012942

Citations 1

Authors

Won-Joong Kim

Woosung Lim

Affiliations

Soon will be listed here.

Abstract

Purpose: Breast-conserving surgery (BCS) is a surgical method designed to minimize intraoperative tissue injury. Although this technique is minimally invasive, it can cause significant postoperative pain and may be a risk factor for persistent pain. Erector spinae plane block (ESPB) is an easy interfascial plane block for analgesia in patients undergoing breast surgery. The primary outcome was the numeric rating scale scores measured separately on the breast and axilla. Secondary outcomes included correlation between pain score and skin sensitivity test.

Methods: Forty patients were divided into 2 groups (ESPB group and control group). Patients in the ESPB group received an ESPB 30 minutes before the induction of general anesthesia, whereas patients in the control group did not receive any regional analgesia during the perioperative period.

Results: Median pain scores of the breast were significantly lower in the ESPB group than that in the control group at 12, 24, and 48 hours after surgery. However, the median pain scores of the axilla were not significantly different between the groups, and the pain score was unrelated to skin sensitivity.

Conclusion: ESPB can effectively alleviate acute postoperative pain with an opioid-sparing analgesic technique in patients undergoing BCS, and a strong correlation is lacking between pain scores and skin sensitivity test.

Citing Articles

A Comparative Study of Placebo Versus Opioid-Free Analgesic Mixture for Mastectomies Performed Under General Anesthesia Along With Erector Spinae Plane Block.

B M, Munireddy Papireddy S, P N S, Tarigonda S Cureus. 2023; 15(1):e34457.

PMID: 36874747 PMC: 9981211. DOI: 10.7759/cureus.34457.

References

Veiga M, Costa D, Brazao I . Erector spinae plane block for radical mastectomy: A new indication?. Rev Esp Anestesiol Reanim (Engl Ed). 2017; 65(2):112-115. DOI: 10.1016/j.redar.2017.08.004. View

Kunigo T, Murouchi T, Yamamoto S, Yamakage M . Injection Volume and Anesthetic Effect in Serratus Plane Block. Reg Anesth Pain Med. 2017; 42(6):737-740. DOI: 10.1097/AAP.0000000000000649. View

Ueshima H, Hiroshi O . RETRACTED: Spread of local anesthetic solution in the erector spinae plane block. J Clin Anesth. 2017; 45:23. DOI: 10.1016/j.jclinane.2017.12.007. View

Andersen K, Duriaud H, Jensen H, Kroman N, Kehlet H . Predictive factors for the development of persistent pain after breast cancer surgery. Pain. 2015; 156(12):2413-2422. DOI: 10.1097/j.pain.0000000000000298. View

Kot P, Rodriguez P, Granell M, Cano B, Rovira L, Morales J . The erector spinae plane block: a narrative review. Korean J Anesthesiol. 2019; 72(3):209-220. PMC: 6547235. DOI: 10.4097/kja.d.19.00012. View

Lee J, Hu H, Brummett C, Syrjamaki J, Dupree J, Englesbe M . Postoperative Opioid Prescribing and the Pain Scores on Hospital Consumer Assessment of Healthcare Providers and Systems Survey. JAMA. 2017; 317(19):2013-2015. PMC: 5815008. DOI: 10.1001/jama.2017.2827. View

Kehlet H, Jensen T, Woolf C . Persistent postsurgical pain: risk factors and prevention. Lancet. 2006; 367(9522):1618-25. DOI: 10.1016/S0140-6736(06)68700-X. View

Munoz-Leyva F, Mendiola W, Bonilla A, Cubillos J, Moreno D, Chin K . In Reply to "Continuous Erector Spinae Plane (ESP) Block: Optimizing the Analgesia Technique". J Cardiothorac Vasc Anesth. 2018; 32(5):e3-e4. DOI: 10.1053/j.jvca.2018.03.033. View

De Cassai A, Tonetti T . Local anesthetic spread during erector spinae plane block. J Clin Anesth. 2018; 48:60-61. DOI: 10.1016/j.jclinane.2018.05.003. View

10.

Altiparmak B, Korkmaz Toker M, Uysal A, Turan M, Gumus Demirbilek S . Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of patients after radical mastectomy surgery: A prospective, randomized, controlled trial. J Clin Anesth. 2018; 54:61-65. DOI: 10.1016/j.jclinane.2018.10.040. View

11.

Forero M, Rajarathinam M, Adhikary S, Chin K . Erector spinae plane block for the management of chronic shoulder pain: a case report. Can J Anaesth. 2017; 65(3):288-293. DOI: 10.1007/s12630-017-1010-1. View

12.

Forero M, Adhikary S, Lopez H, Tsui C, Chin K . The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016; 41(5):621-7. DOI: 10.1097/AAP.0000000000000451. View

13.

Huang W, Wang W, Xie W, Chen Z, Liu Y . Erector spinae plane block for postoperative analgesia in breast and thoracic surgery: A systematic review and meta-analysis. J Clin Anesth. 2020; 66:109900. DOI: 10.1016/j.jclinane.2020.109900. View

14.

Leong R, Tan E, Wong S, Tan K, Liu C . Efficacy of erector spinae plane block for analgesia in breast surgery: a systematic review and meta-analysis. Anaesthesia. 2020; 76(3):404-413. DOI: 10.1111/anae.15164. View

15.

Kashiwagi S, Asano Y, Watanabe M, Takii M, Morisaki T, Aomatsu N . [Day surgery of early breast cancer treated with breast-conserving operation following sentinel lymph node navigation biopsy under local anesthesia]. Gan To Kagaku Ryoho. 2012; 39(12):1914-6. View

16.

Ueshima H, Otake H . RETRACTED: Limitations of the Erector Spinae Plane (ESP) block for radical mastectomy. J Clin Anesth. 2018; 51:97. DOI: 10.1016/j.jclinane.2018.08.013. View

17.

Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A . Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002; 347(16):1227-32. DOI: 10.1056/NEJMoa020989. View

18.

Gottschalk A, Smith D . New concepts in acute pain therapy: preemptive analgesia. Am Fam Physician. 2001; 63(10):1979-84. View

19.

Sekandarzad M, Van Zundert A, Lirk P, Doornebal C, Hollmann M . Perioperative Anesthesia Care and Tumor Progression. Anesth Analg. 2016; 124(5):1697-1708. DOI: 10.1213/ANE.0000000000001652. View

20.

Janis J, Joshi G . Introduction to "current concepts in pain management in plastic surgery". Plast Reconstr Surg. 2014; 134(4 Suppl 2):6S-7S. DOI: 10.1097/PRS.0000000000000683. View