Comparison between Erector Spinae Plane Block and Thoracic Epidural in Breast Cancer Surgeries under General Anesthesia

Abstract

Background: Thoracic epidural (TE) analgesia was considered as the gold standard for intraoperative and postoperative analgesia in breast surgeries. However, it is not routinely used because of its associated hemodynamic effects. Erector spinae plane (ESP) block is recognized as a promising perioperative analgesic intervention in breast surgeries. Aim of the study: To compare between ESP block and TE analgesia in unilateral breast cancer surgeries without axillary clearance performed under general anesthesia. Patient and Methods: Forty female patients scheduled for unilateral cancer breast surgeries without axillary clearance under general anesthesia were enrolled in this study. After induction of general anesthesia patients were divided into two groups; TE group received single-shot 10 ml 0.25% bupivacaine in the thoracic epidural space, while ESP group received single-shot 20 ml 0.25% bupivacaine ultrasound-guided erector spinae plane block. The primary outcome was to assess the analgesic effects through recording intraoperative fentanyl consumption and postoperative narcotic consumption (morphine in the post anesthesia care unit (PACU) and pethidine in the surgical ward), visual analogue scale (VAS) score for pain assessment in the first postoperative 24 hours. The secondary outcomes were to compare hemodynamic changes and any complications related to the technique or drugs used, and patient satisfaction. Results: No statistical differences were found between the two groups regarding their demographic data. As regards narcotic consumption; intraoperative fentanyl consumption was significantly higher in ESP group (p< 0.001), post-operative morphine consumption in PACU was not statistically different between the groups (p 0.67), while pethidine consumption in the surgical ward was higher in TE group (p <0.001). Concerning pain assessment, VAS scores in ESP group were statistically lower when compared with TE group starting from 2 hours till 12 hours postoperatively, and higher in patients’ satisfaction about analgesia in the first 24 hours postoperatively (i.e., 95% satisfied in ESP versus 55% in TE) (p value 0.01). As regards hemodynamic effects; TE group showed lower mean arterial blood pressure (MAP) recordings with significant difference between the ESP group at 10 min., 30 min. and 1 hr. after the intervention (p-value 0.034, <0.001 and 0.006 respectively), TE group showed significant difference with lower heart rate recordings in comparison to ESP group; at 30 min after the block (p-value 0.002). Conclusion: The current study revealed that ESP block showed lower postoperative pethidine consumption and lower VAS scores from 2 hrs. Till 12 hrs. Postoperatively, while TE block showed lower intraoperative fentanyl consumption. ESP block showed better hemodynamic stability and higher patients’ satisfaction to analgesia. We propose that ESP block should be included in the armamentarium of regional analgesic techniques for breast surgeries.