Volume 20 No 12 (2022)
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Comparison of the Effects of Ultrasound-Guided Erector Spinae Plane Block Versus Retrolaminar Block on Postoperative Analgesia after Modified Radical Mastectomy in Suez Canal University Hospitals
Ahmed Mohamed Adly Ramadan, Alaa ElDin Mohamed ElKassaby, Salah Abdel Fattah M. Ismail, Ahmad Hamed Altouny, Medhat Lamei Shaker
BACKGROUND: The increasing incidence of breast cancer has led to an increased number of patients getting operated for breast surgery. Blockade of nociceptive inputs via the intercostal nerves is important for postoperative pain control after breast surgery, because cutaneous innervation of the breast is mainly derived from the intercostal nerves, with a small contribution from the supraclavicular nerves.AIM: This study aimed to improve pain management in patients undergoing modified radical mastectomy through setting regional blocks as a protocol at Suez Canal university hospitals.PATIENTS AND METHODS: This prospective comparative randomized double blinded clinical trial study was carried out at the operative theatre in Suez Canal University Hospitals. This study included 122 American Society of Anesthesiologists (ASA) physical status I and ІІ female patients aged 18-65 years scheduled for elective unilateral modified radical mastectomy under general anesthesia were enrolled into the study. Patients were randomly allocated into two groups Group I (Group E): 61 Patients received ultrasound-guided erector spinae plane block with 30 ml of bupivacaine 0.25%. Group II (Group R): 61 Patients received ultrasound-guided retrolaminar block with 30 ml of bupivacaine 0.25%.RESULTS: The mean time to 1st request of analgesia in group E was (6.54 ± 4.653 hours), in the group R (5.93 ± 4.457 hours), without statistically significant difference between them (p=0.630). The mean morphine consumption in the group E was (7.21 ± 4.340 mg), in the group R (7.11 ± 4.219 mg), without statistically significant difference between them (p=0.909). Regarding the satisfaction score in the studied groups. In group E, it was found that most participants 32 (52.5%) were very satisfied, 18 (29.5%) were satisfied, 11 (18.0%) were neither, nor 0 (0.0%) were dissatisfied. In group R, it was found that most participants 23 (37.7%) were satisfied, 21 (34.4%) were very satisfied, 14 (23.0%) were neither, nor 3 (4.9%) were dissatisfied, without statistically significant difference between both groups any of the satisfaction score (p=0.100). About the relevant postoperative complications in the current study, no statistically significant difference between both groups regarding any of the postoperative complications. Concerning time to complete block in the current study, the mean time to complete block was shorter in group E than group R, without significant difference between both (p= 0.076). Regarding block difficulty in the current study, in group E; most cases 41 (67.2%) had an easy procedure, rather difficult in 19 (31.1%), and difficult in 1 (1.6%). While in group R, about half of patients 31 (50.8%) had an easy procedure, rather difficult in 27 (44.3%), and difficult in 3 (4.9%), without significant difference between both (p= 0.151).CONCLUSION: This study failed to detect a difference in terms of time to first post-operative rescue analgesic administration after the block procedure between ESPB and RLB in patients undergoing breast surgery. Future clinical studies are needed to confirm the anatomical mechanisms of action of both blocks, as well as the appropriate concentration, the optimal timing and volume of local anesthetics required for adequate ESPB or RLB.
ESPB, RLB, Breast surgery, VAS, NRS.
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