Analgesia and spread of Erector Spinae Plane Block in breast cancer surgeries: a randomized controlled trial

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Abstract Background: The goal of this study was to evaluate varying volumes of ESPB on analgesia, LA spread, sedation, and patient satisfaction.Methods: 60 patients aged between 18 and 50 years with an ASA I-II and scheduled for breast cancer surgery were randomized to receive either ESPB with 20 ml 0.25% bupivacaine (Standard volume ESPB), or with 40 ml 0.125% bupivacaine (High volume ESPB), or no ESPB (GA only group). The primary outcome was pain intensity evaluated by the VAS, 12 hours after surgery. P-values < 0.05 were considered the cutoff point for statistical significance. The secondary outcomes were pain at rest and pain on movement evaluated by the VAS, craniocaudal injectate spread, to PV space and epidural space assessed by CT, clinical dermatomal spread, level of sedation assessed by RASS, and patient satisfaction with anaesthesia and analgesia.Results: VAS at rest 12 h after surgery was less in both intervention groups compared with the control (1.75 ± 0.79 vs. 1.6 ± 0.88 vs. 3.4 ± 1.96, p = 0.001). In other time points, VAS was less in each ESPB group compared to GA only during rest and movement and the volume injected made no difference. The LA had extended further in the high volume group than the standard volume group (11.20 ± 3.07 vs. 9.15 ± 2.54 vertebral levels, p = 0.027). No difference of the spread to PV space or epidural space between the 2 intervention groups. More dermatomes were covered in the high volume group (7.20 ± 2.12 vs. 5.75 ± 1.37 dermatomes, p = 0.014). Agitation was higher in GA only group than both ESPB groups in the first 8 postoperative hours. Patient satisfaction was higher in both ESPB groups compared to GA only group.Conclusions: Preoperative ESPB is an excellent analgesic modality that should be considered in breast cancer surgeries. Apart from analgesia it attenuates postoperative agitation and enhances patient satisfaction. Volume injected has no effect on analgesia or patient satisfaction but it results in more LA spread.Trial registration: NCT04796363 (12/3/2021)

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