The quality of recovery after erector spinae plane block in patients undergoing breast surgery: a randomized controlled trial

Marcin Wiech; Paweł Piwowarczyk; Marcin Mieszkowski; Bułat Tuyakov; Karolina Pituch-Sala; Tomasz Czarnik; Andrzej Kurylcio; Mirosław Czuczwar; Michał Borys

doi:10.1186/s12871-022-01760-z

The quality of recovery after erector spinae plane block in patients undergoing breast surgery: a randomized controlled trial

BMC Anesthesiol. 2022 Jul 14;22(1):222. doi: 10.1186/s12871-022-01760-z.

Authors

Affiliations

¹ Second Department of Anesthesiology and Intensive Care Medicine, Medical University of Lublin, ul. Staszica 16, 20-081, Lublin, Poland.
² Department of Anesthesiology and Intensive Care, Regional Specialist Teaching Hospital, Olsztyn, Poland.
³ Department of Anesthesiology and Intensive Care, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Al. Warszawska 30, 10-082, Olsztyn, Poland.
⁴ Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, Opole University, Opole, Poland.
⁵ Department of Surgical Oncology, Medical University of Lublin, ul. Radziwiłłowska 13, 20-080, Lublin, Poland.
⁶ Second Department of Anesthesiology and Intensive Care Medicine, Medical University of Lublin, ul. Staszica 16, 20-081, Lublin, Poland. michalborys1@gmail.com.

Abstract

Background: The erector spinae plane (ESP) block has recently been shown to effectively alleviate postoperative pain and reduce opioid consumption in breast surgery patients. However, data are still limited concerning the quality of recovery in patients following this procedure.

Methods: This study was a randomized controlled trial (RCT) performed in a university hospital. We randomly allocated patients to one of three groups: ESP, SHAM, and control (CON). Procedures in the ESP and SHAM blocks were performed ipsilaterally with 0.375% ropivacaine or 0.9% saline (0.4 mL/kg). Our primary outcome was the assessment of the patient's improvement with quality-of-recovery 40 (QoR-40) a day after surgery. Other outcome assessments included postoperative pain evaluation on the visual analog scale (VAS), 24-hour opioid consumption with patient-controlled analgesia (PCA), time to the first opioid demand, and global satisfaction with perioperative treatment.

Results: Overall, patients in the ESP group had improved QoR-40 compared to the CON group, 186 [177-193] vs. 175 [165-183] (medians and interquartile ranges). Pain severity was significantly higher in the CON group compared to the ESP group at hours 2 (38 [23-53] vs. 20 [7-32]) and 4 (30 [18-51] vs. 19 [7-25]). Moreover, we observed lower oxycodone consumption after 24 hours with the PCA pump between the ESP (4 [2-8] mg) and the CON (9.5 [5-19]) groups. Patients in the CON group used PCA sooner than those in the ESP group. Participants in the ESP group were more satisfied with treatment than those in the CON group. We found no statistical difference between SHAM and the other groups.

Conclusions: Compared to the CON group, the ESP block improved the quality of recovery, alleviated pain intensity, and lowered opioid consumption in patients undergoing breast surgery. However, we did not observe this superiority in comparison with the SHAM group.

Trial registration: NCT04726878 .

Keywords: Breast surgery; Erector spinae plane block; Patient-controlled analgesia; Quality of recovery; Visual analog scale.

Publication types

Randomized Controlled Trial

MeSH terms

Analgesics, Opioid / therapeutic use
Anesthetics, Local
Breast Neoplasms*
Female
Humans
Nerve Block* / methods
Pain, Postoperative / prevention & control
Ultrasonography, Interventional / methods

Substances

Analgesics, Opioid
Anesthetics, Local

Associated data

ClinicalTrials.gov/NCT04726878