Effectiveness of Ultrasound Guided Erector Spinae Plane Block Compared to Ultrasound Guided Modified Pectoral Nerves Block in Modified Radical Mastectomy: A Randomized Single Blinded Study

Abstract

Background: Approximately, 40–60% of breast surgeries are associated with severe acute pain. The goal of this work was to compare the analgesic effectiveness and safety between erector spinae plane block (ESPB) and modified pectoral nerve block (MPECB) in patients having modified radical mastectomy (MRM). Methods: This randomized single blinded study included 60 adult female aged 18–65, American Society of Anesthesiologists (ASA) I, II, III patients with body mass index between 20 and 35 kg/m2 who underwent MRM under general anesthesia (GA). Patients were divided into two equal groups. ESPB group received ESPB 30 mL levobupivacaine 0.25%, MPECB group received MPECB 10 ml levobupivacaine 0.25%. Blocks were done before induction of GA. Mean arterial blood pressure (MAP) and heart rate (HR) and numeric rating scale (NRS) were measured at PACU, 2, 4, 8, 12, 16, 20 and 24 h postoperatively, postoperative nausea and vomiting (PONV), assessed on a four-point verbal scale. Results: Postoperative morphine consumption was significantly lower in MPECB group than in ESPB group. Numeric pain scale scores were significantly lower in MPECB patients both at rest and during movement than ESPB groups. Ramsey score in MPECB patients had better sedation scores in the first 4 h post-operative than ESPB group. Patients who received MPECB showed less PONV, but it was statistically insignificant and intramuscular hematoma was insignificantly higher in MPECB group. Conclusions: MPECB provides safe and more effective analgesia in MRM compared to ESPB in the form of lower postoperative morphine consumption and low NRS scores.