The Analgesic Effects and Sensory Blockade between Erector Spinae Plane Block and Thoracic Paravertebral Block after Breast Surgery
Article Sidebar
Main Article Content
Abstract
Background: Thoracic paravertebral block (TPVB) is an
effective technique for controlling pain after breast surgery.
However, this block requires high skill to perform.
In contrast, Erector spinae plane block (ESPB) seem to
be easier and safer technique.
Objectives: To evaluate the analgesic effects and sensory
blockade between ESPB and TPVB after breast surgery.
Methods: This retrospective study was conducted in
patients undergoing breast surgery from June to October
2018 who received either TPVB or ESPB for postoperative
pain control. The study data include pain scores (visual
analog scale: VAS), the scanning and block performing
time, dermatomal levels of sensory blockade, postoperative
fentanyl used and complications.
Results: Twenty-four patients, received TPVB 10 and
ESPB 14 patients. Patient demographic data were
comparable. The mean differences of VAS within 24 hours
at rest and on movement were similar (-9.1, P 0.263 and
7.4, P 0.387). The scanning and block performing time
were significantly shorter in ESPB (38 vs. 200 seconds,
P 0.005 and 220 vs. 457 seconds, P 0.003). The dermatomal
level of sensory blockade and postoperative fentanyl used
were also similar. No complications were observed in
either group.
Conclusions: ESPB and TPVB provide similar
postoperative pain effect and sensory blockade after
breast surgery but ESPB required a shorter time of
scanning and performing.
Article Details
References
mortality and epidemiology of breast cancer in the world.
Asian Pac J Cancer Prev 2016;17(S3):43-6.
2. Kulkarni AR, Pusic AL, Hamill JB, et al. Factors associated
with acute postoperative pain following breast reconstruction.
JPRAS Open. 2017;11:1-13. doi: 10.1016/j.jpra.2016.08.005.
3. Moller JF, Nikolajsen L, Rodt SA, Ronning H, Carlsson PS.
Thoracic paravertebral block for breast cancer surgery: A
randomized double-blind study. Anesth Analg 2007;105(6):
1848-51.
4. Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass
RA. Thoracic paravertebral block for breast surgery. Anesth
Analg 2000;90(6):1402-5.
5. Chelly JE. Paravertebral Blocks. Anesthesiol Clin 2012;
30(1):75-90.
6. Hara K, Sakura S, Nomura T, Saito Y. Ultrasound guided
thoracic paravertebral block in breast surgery. Anaesthesia
2009;64(2):223-5. doi: 10.1111/j.1365-2044.2008.05843.x.
7. Gürkan Y, Aksu C, Ku A, Yörüko UH, Cennet TK. Ultrasound
guided erector spinae plane block reduces postoperative
opioid consumption following breast surgery : A randomized
controlled study. J Clin Anesth 2018;50:65-8.
8. Bonvicini D, Tagliapietra L, Giacomazzi A, Pizzirani E.
Bilateral ultrasound-guided erector spinae plane blocks in
breast cancer and reconstruction surgery. J Clin Anesth
2018;44:3-4. doi.org/10.1016/j.jclinane.2017.10.006.
9. Conlon NP, Shaw AD, Grichnik KP. Postthoracotomy
paravertebral analgesia: will it replace epidural analgesia?
Anesthesiol Clin 2008;26(2):369-80.
10. Davies RG, Myles PS GJ. A comparison of the analgesic
efficacy and side-effects of paravertebral vs epidural
blockade for thoracotomy systematic review and metaanalysis
of randomized trials. Br J Anaesth 2006;96:418-26.
11. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector
spinae plane block a novel analgesic technique in thoracic
neuropathic pain. Reg Anesth Pain Med 2016;41(5):621-7.
12. Tulgar S, Sertan M, Senturk O, Selvi O, Ercan T. Evaluation
of ultrasound-guided erector spinae plane block for
postoperative analgesia in laparoscopic cholecystectomy :
A prospective , randomized , controlled clinical trial. J Clin
Anesth 2018;49:101-6. doi.org/10.1016/j.jclinane.2018.06.019.
13. Tulgar S, Kose HC, Selvi O, et al. Comparison of ultrasoundguided
lumbar erector spinae plane Block and transmuscular
quadratus lumborum block for postoperative analgesia in
hip and proximal femur surgery: A prospective randomized
feasibility study. Anesth Essays Res 2018;12(4):825-31.
163
อุ้มจิต วิทยาโรจน์ และคณะ Aumjit Wittayapairoj, et al.
วิสัญญีสาร 2562; 45(4) Thai J Anesthesiol 2019; 45(4): 156-63.
14. Singh S, Choudhary NK, Lalin D, Verma VK. Bilateral
ultrasound-guided erector spinae plane block for
postoperative analgesia in lumbar spine surgery. J Neurosurg
Anesthesiol 2019; 26. doi: 10.1097/ANA.0000000000000603.
15. Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic
efficacy of pre-operative bilateral erector spinae plane (ESP)
blocks in patients having ventral hernia repair. Anaesthesia
2017;72:452-60.
16. Jin L, Wen L, Zhang Y, Li G, Sun P, Zhou X. Thoracic
paravertebral regional anesthesia for pain relief in patients
with breast cancer surgery. Medicine (Baltimore)
2017;96(39):e8107. doi: 10.1097/MD.0000000000008107.
17. Kasimahanti R, Arora S, Bhatia N, Singh G. Ultrasoundguided
single- vs double-level thoracic paravertebral block
for postoperative analgesia in total mastectomy with axillary
clearance. J Clin Anesth 2016;33:414-21.
18. Hamilton DL, Manickam B. Erector spinae plane block for
pain relief in rib fractures. Br J Anaesth 2017; 118:474-5.
19. Tsui BCH, Fonseca A, Munshey F, McFadyen G, Caruso TJ.
The erector spinae plane (ESP) block: A pooled review of
242 cases. J Clin Anesth 2019;53:29-34.
20. Ahiskalioglu A, Alici HA, Ciftci B, Celik M, Karaca O.
Continuous ultrasound guided erector spinae plane block
for the management of chronic pain. Anaesth Crit Care Pain
Med 2018;38(4):395-6.
21. Kalani S, Kumar CVP, Dulara SC. Comparison between
Single-level and multi-level unilateral thoracic paravertebral
block in patients undergoing modified radical mastectomy.
Indian J Pain 2018;31(3):180-5.
22. Orozco E, Enrique Serrano R, Pahola Rueda-Rojas V. Erector
spinae plane (ESP) block for postoperative analgesia in total
radical mastectomy: case report. Rev Colomb Anestesiol
2018;46(Sup):71-3.
23. Veiga M, Costa D, Brazão I. Erector spinae plane block for
radical mastectomy: A new indication? Rev Esp Anestesiol
Reanim 2018;65(2):112-5.
24. Ueshima H, Otake H. Clinical experience of ultrasoundguided
erector spinae plane block for thoracic vertebral
surgery. J Clin Anesth 2017;38:137.
25. Ivanusic J, Konishi Y, Barrington MJ. A cadaveric study
investigating the mechanism of action of erector spinae
blockade. Reg Anesth Pain Med 2018;43(6):567-71.
26. Elsharkawy H, Pawa A, Mariano E. Interfascial plane blocks:
back to basics. Reg Anesth Pain Med 2018;43:341-6.