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Bilateral Ultrasound-Guided Erector Spinae Plane Block for Perioperative Analgesia in Breast Reduction Surgery: A Prospective Randomized and Controlled Trial

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  • Breast Surgery
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Abstract

Background

Ultrasound-guided erector spinae plane block (ESPB) is an interfascial plane block used for analgesia of the chest and abdominal wall. This study aimed to evaluate the perioperative analgesic efficacy of bilateral single-shot ESPB at T5 vertebral level in breast reduction surgery.

Materials and Methods

Sixty adult female patients scheduled for breast reduction surgery were included and randomly allocated to two groups to receive either preoperative ESPB with a local anesthetic mixture of 10 mL 0.5% bupivacaine, 5 mL 2% lidocaine, and 5 mL saline, or sham block. Patients in both groups received intraoperative remifentanil infusion and, postoperatively, morphine via the patient-controlled analgesia (PCA) device. The primary outcome was 24-h total morphine consumption, and secondary outcomes included intraoperative opioid consumption, postoperative pain intensity, time to first PCA request, supplement analgesic requirements, functional recovery, patient satisfaction, length of hospital stay, and side effects and complications.

Results

The 24-h total morphine consumption was significantly lower in the ESPB group vs. the sham group (mean ± SD, 6.7 ± 3.9, and 13.9 ± 5.7 mg, respectively, p < 0.001). Compared with sham block, ESPB reduced pain scores, intraoperative opioid consumption, supplement analgesic requirements, delayed time to first PCA request, and improved functional recovery and patient satisfaction.

Conclusion

In breast reduction surgery, preoperative single-shot ESPB reduces perioperative opioid consumption and provides adequate pain relief within 24 h postoperatively compared to systemic analgesics alone.

Trial Registration Number: NCT03621345

Level of Evidence II

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Acknowledgments

This study was supported financially by the Scientific Research Projects Unit of Cukurova University in Turkey. No other external funding declared. The authors of this article would like to thank everyone who played a role in carrying out this research.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care, Faculty of Medicine, Cukurova University, Balcali Hospital, Adana, Turkey

    Demet Lafli Tunay, Murat T. Ilginel, Feride Karacaer & Ebru Biricik

  2. Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Cukurova University, Balcali Hospital, Adana, Turkey

    Ibrahim Tabakan

  3. Department of Anesthesiology and Intensive Care, Baskent University School of Medicine, Adana, Turkey

    Ozlem Ozmete

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  1. Demet Lafli Tunay
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Contributions

Demet Lafli Tunay was involved in conceptualization, design, supervision, literature review, conduction, and writing—original draft preparation, Murat T. Ilginel helped in methodology, data collection and processing, writing—review and editing, Feride Karacaer contributed to project administration, supervision, data collection, and critical review, Ebru Biricik was involved in methodology, analysis and interpretation and critical review, Ibrahim Tabakan helped in methodology, literature review, writing—review and editing, Ozlem Ozmete contributed to analysis and interpretation, data curation, writing—review and editing. All authors contributed to the final manuscript revisions and approved the final version.

Corresponding author

Correspondence to Demet Lafli Tunay.

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Conflict of interest

The authors declare no conflict of interest.

Ethical Approval

The study was registered at the Cukurova University Clinical Research Ethics Committee on 19 July 2019 (approval number: 88/2). ClinicalTrials.gov registration was also filed with the registration number of NCT03621345. The study was conducted at Cukurova University in Turkey following the most recent version of the Declaration of Helsinki after written informed patient consent was obtained from all patients.

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Tunay, D.L., Ilginel, M.T., Karacaer, F. et al. Bilateral Ultrasound-Guided Erector Spinae Plane Block for Perioperative Analgesia in Breast Reduction Surgery: A Prospective Randomized and Controlled Trial. Aesth Plast Surg 47, 1279–1288 (2023). https://doi.org/10.1007/s00266-023-03315-0

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