The Effect of Erector Spina Plan Block on Acute and Chronic Pain in Breast Cancer Surgery: A Retrospective Study
Abstract
Objective: In this study, it was aimed to evaluate effects of erector spinae plane block on postoperative analgesic consumption, pain scores, patient satisfaction and chronic pain after breast cancer surgery.
Material and methods: After ethic approval, we retrospectively reviewed patients who underwent elective breast cancer surgery between September 2018-December 2019. 40 patients were included to the study after exclusion criterias. Patients were divided into ESPB group (n=20) and control group (n=20). We recorded postoperative morphine consumption. The pain assessed by Visual Analog Scale (VAS) score. Chronic and neuropathic pain incidence were assessed at 3 and 6 months.
Results: The morphine consumption within postoperative 24 hours was significantly higher in ESPB group than controls (p<0.05). VASstatic scores were lower in ESPB group than control except 24. hour (p<0.05). VASdynamic scores were comparable between groups except 12. and 18. hours (p>0.05). The additional analgesic consumption was significantly lower in ESPB group than controls (p<0.05). The patient satisfaction was higher in ESPB group when compared to controls (p<0.05). There was no significant difference incidence of nausea-vomiting (p>0.05). The persistent pain after breast cancer surgery (PPBCS) was found to be 23% and 8% on months 3 and 6, respectively, indicating no significant difference between groups (p>0.05). Neuropathic component was not considered in patients with pain (LANSS≤12).
Conclusion: Lower systemic opioid consumption and lower VAS scores with ESPB suggests that ESBP can be effectively used as part of postoperative multimodal analgesia However, similar incidence of PPBCS suggests that ESPB may be ineffective in long term.
Keywords
acute postoperative pain nerve block breast surgery opioid analgesics chronic postoperative pain
References
- Miller KD, Nogueira L, Devasia T, Mariotto AB, Yabroff KR, Jemal A, et al. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin. 2022;72(5):409–36.
- Wang L, Cohen JC, Devasenapathy N, Hong BY, Kheyson S, Lu D, et al. Prevalence and intensity of persistent post-surgical pain following breast cancer surgery: a systematic review and meta-analysis of observational studies. Br J Anaesth. 2020;125(3):346–57.
- Woodworth GE, Ivie RMJ, Nelson SM, Walker CM, Maniker RB. Perioperative Breast Analgesia: A Qualitative Review of Anatomy and Regional Techniques. Reg Anesth Pain Med. 2017;42(5):609–31.
- Andersen KG, Kehlet H. Persistent Pain After Breast Cancer Treatment: A Critical Review of Risk Factors and Strategies for Prevention. J Pain. 2011;12(7):725–46.
- Gelman D, Gelmanas A, Urbanaitė D, Tamošiūnas R, Sadauskas S, Bilskienė D, et al. Role of Multimodal Analgesia in the Evolving Enhanced Recovery after Surgery Pathways. Med Kaunas Lith. 2018;54(2).
- Albrecht E, Chin KJ. Advances in regional anaesthesia and acute pain management: a narrative review. Anaesthesia. 2020;75 Suppl 1:e101–10.
- Karmakar MK. Thoracic Paravertebral Block. Anesthesiology. 2001;95(3):771–80.
- Song L, Zhou Y, Huang D. Inadvertent posterior intercostal artery puncture and haemorrhage after ultrasound-guided thoracic paravertebral block: a case report. BMC Anesthesiol. 2018;18(1):196.
- Garg R, Bhan S, Vig S. Newer regional analgesia interventions (fascial plane blocks) for breast surgeries: Review of literature. Indian J Anaesth. 2018;62(4):254–62.
- Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621–7.
- Bakshi SG, Karan N, Parmar V. Pectoralis block for breast surgery: A surgical concern?. Indian J Anaesth. 2017;61(10):851–2.
- Lim H, Mathew C, Wong SN, Liu CW. Anatomical insights into injectate spread after thoracic erector spinae plane block: A systematic review. J Clin Anesth. 2024;92:111304.
- Karmakar MK, Lönnqvist P-A. The clinical use of the thoracic erector spinae plane block. Con - ESPB is not useful for thoracic analgesia. J Clin Anesth. 2024;93:111353.
- De Cassai A, Bonanno C, Padrini R, Geraldini F, Boscolo A, Navalesi P, et al. Pharmacokinetics of lidocaine after bilateral ESP block. Reg Anesth Pain Med. 2021;46(1):86–9.
- Chin KJ, Lirk P, Hollmann MW, Schwarz SK. Mechanisms of action of fascial plane blocks: a narrative review. Reg Anesth Pain Med. 2021;46(7):618–28.
- Leong RW, Tan ESJ, Wong SN, Tan KH, Liu CW. Efficacy of erector spinae plane block for analgesia in breast surgery: a systematic review and meta-analysis. Anaesthesia. 2021;76(3):404–13.
- Lacomba MT, Del Moral OM, Zazo JLC, Gerwin RD, Goñi AZ. Incidence of myofascial pain syndrome in breast cancer surgery: a prospective study. Clin J Pain. 2010;26(4):320–5.
- Richebé P, Capdevila X, Rivat C. Persistent Postsurgical Pain: Pathophysiology and Preventative Pharmacologic Considerations. Anesthesiology. 2018;129(3):590–607.
- Kim BR, Yoon S-H, Lee H-J. Practical strategies for the prevention and management of chronic postsurgical pain. Korean J Pain. 2023;36(2):149–62.
- Schug SA, Lavand’homme P, Barke A, Korwisi B, Rief W, Treede R-D. The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain. Pain. 2019;160(1):45–52.
- Gong Y, Tan Q, Qin Q, Wei C. Prevalence of postmastectomy pain syndrome and associated risk factors: A large single-institution cohort study. Medicine (Baltimore). 2020;99(20):e19834.
- Langford DJ, Paul SM, West C, Levine JD, Hamolsky D, Elboim C, et al. Persistent Breast Pain Following Breast Cancer Surgery Is Associated With Persistent Sensory Changes, Pain Interference, and Functional Impairments. J Pain. 2014;15(12):1227–37.
- Nogueira S, Rodrigues D, Barros M, Menezes J, Guimarães-Pereira L. Chronic pain after breast surgery: incidence, risk factors and impact on quality of life. Rev Esp Anestesiol Reanim Engl Ed. 2024;71(4):274–81.
- Andersen KG, Kehlet H. Persistent Pain After Breast Cancer Treatment: A Critical Review of Risk Factors and Strategies for Prevention. J Pain. 2011;12(7):725–46.
- Meretoja TJ, Leidenius MHK, Tasmuth T, Sipilä R, Kalso E. Pain at 12 Months After Surgery for Breast Cancer. JAMA. 2014;311(1):90–2.
- De Cassai A, Bonanno C, Sandei L, Finozzi F, Carron M, Marchet A. PECS II block is associated with lower incidence of chronic pain after breast surgery. Korean J Pain. 2019;32(4):286–91.
- Versyck B, van Geffen G-J, Van Houwe P. Prospective double blind randomized placebo-controlled clinical trial of the pectoral nerves (Pecs) block type II. J Clin Anesth. 2017;40:46–50.
- Versyck B, Groen G, Kampen J, Van Houwe P. The effect of pectoral block type II on persistent pain: Follow up of a randomised trial and hypotheses for further analyses. Eur J Anaesthesiol. 2019;36(1):75–7.
- Sulak M, Ahiskalioglu A, Yayik A, Karadeniz E, Celik M, Demir U, et al. The effect of ultrasound-guided serratus plane block on the quality of life in patients undergoing modified radical mastectomy and axillary lymph node dissection: a randomized controlled study. Anaesthesiol Intensive Ther. 2022;54(1):48–55.
- Genc C, Kaya C, Bilgin S, Dost B, Ustun YB, Koksal E. Pectoserratus plane block versus erector spinae plane block for postoperative opioid consumption and acute and chronic pain after breast cancer surgery: A randomized controlled trial. J Clin Anesth. 2022;79:110691.
- Ciftci B, Altiparmak B, Tekin B, Sakul BU, Alici HA. Does ESPB performed at the level of T4 cover axillary area? A cadaveric study. J Clin Anesth. 2021;73:110362.
Meme Kanseri Cerrahisinde Erektör Spina Plan Bloğunun Akut ve Kronik Ağrıya Etkisi: Retrospektif Çalışma
Abstract
Amaç: Bu çalışmanın amacı meme kanseri cerrahisinde erektör spina plan bloğunun post-operatif analjezik tüketimi, ağrı skorları, hasta memnuniyeti ve cerrahi sonrası persistan ağrı üzerine olan etkisini araştırmaktır.
Gereç ve Yöntemler: Etik kurul onayı alındıktan sonra Eylül 2018-Aralık 2019 tarihleri arasında elektif meme kanseri geçiren hastalar retrospektif olarak incelendi. Dışlanma kriterleri uygulandıktan sonra kalan 40 hasta çalışmaya alındı. Hastalar ESPB grubu (n=20) ve kontrol grubu (n=20) olarak ikiye ayrıldı. Hastaların postoperatif morfin tüketim miktarı kaydedildi. Vizüel Analog Skala (VAS) kullanılarak değerlendirilen ağrı skorları değerlendirildi. Taburculuk sonrası 3. ve 6. aydaki kronik ve nöropatik ağrı insidansı kaydedildi.
Bulgular: Postoperatif ilk 24 saatteki morfin tüketimi tüm ölçüm zamanlarında ESPB grubunda kontrol grubundan daha düşüktü (p<0,05). VASstatik skorları 24. saat hariç tüm ölçüm zamanlarında ESPB grubunda kontrol grubundan daha düşüktü (p<0,05). VASdinamik skorları 12. ve 18. saat hariç gruplar arasında benzerdi (p>0,05). Ek analjezik tüketimi EPSB grubunda kontrol grubundan daha düşüktü (p<0,05). Hasta memnuniyeti ESPB grubunda istatistiksel olarak daha yüksekti (p<0,05). Bulantı-kusma insidansı arasında gruplar arasında farklılık yoktu (p>0,05). Meme kanseri cerrahisi sonrası persistan ağrı (MKCPA), 3. ve 6. ayda sırasıyla %23 ve %8 bulundu ve iki grup arasında anlamı bir fark yoktu (p>0,05). Ağrısı olan tüm hastalarda nöropatik komponent ön planda düşünülmedi (LANSS≤12)
Sonuç: ESPB ile daha az sistemik opioid tüketimi ve VAS skorlarının gözlemlenmesi, postoperatif multimodal analjezinin bir parçası olarak ESBP’nin etkin bir şekilde kullanılabileceğini göstermektedir. MKCPA insidansının benzer olması, uzun dönemde ESBP’nin etkisiz olabileceğini düşündürmektedir.
Keywords
akut postoperatif ağrı sinir bloğu meme cerrahisi opioid analjezikler kronik postoperatif ağrı
References
- Miller KD, Nogueira L, Devasia T, Mariotto AB, Yabroff KR, Jemal A, et al. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin. 2022;72(5):409–36.
- Wang L, Cohen JC, Devasenapathy N, Hong BY, Kheyson S, Lu D, et al. Prevalence and intensity of persistent post-surgical pain following breast cancer surgery: a systematic review and meta-analysis of observational studies. Br J Anaesth. 2020;125(3):346–57.
- Woodworth GE, Ivie RMJ, Nelson SM, Walker CM, Maniker RB. Perioperative Breast Analgesia: A Qualitative Review of Anatomy and Regional Techniques. Reg Anesth Pain Med. 2017;42(5):609–31.
- Andersen KG, Kehlet H. Persistent Pain After Breast Cancer Treatment: A Critical Review of Risk Factors and Strategies for Prevention. J Pain. 2011;12(7):725–46.
- Gelman D, Gelmanas A, Urbanaitė D, Tamošiūnas R, Sadauskas S, Bilskienė D, et al. Role of Multimodal Analgesia in the Evolving Enhanced Recovery after Surgery Pathways. Med Kaunas Lith. 2018;54(2).
- Albrecht E, Chin KJ. Advances in regional anaesthesia and acute pain management: a narrative review. Anaesthesia. 2020;75 Suppl 1:e101–10.
- Karmakar MK. Thoracic Paravertebral Block. Anesthesiology. 2001;95(3):771–80.
- Song L, Zhou Y, Huang D. Inadvertent posterior intercostal artery puncture and haemorrhage after ultrasound-guided thoracic paravertebral block: a case report. BMC Anesthesiol. 2018;18(1):196.
- Garg R, Bhan S, Vig S. Newer regional analgesia interventions (fascial plane blocks) for breast surgeries: Review of literature. Indian J Anaesth. 2018;62(4):254–62.
- Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621–7.
- Bakshi SG, Karan N, Parmar V. Pectoralis block for breast surgery: A surgical concern?. Indian J Anaesth. 2017;61(10):851–2.
- Lim H, Mathew C, Wong SN, Liu CW. Anatomical insights into injectate spread after thoracic erector spinae plane block: A systematic review. J Clin Anesth. 2024;92:111304.
- Karmakar MK, Lönnqvist P-A. The clinical use of the thoracic erector spinae plane block. Con - ESPB is not useful for thoracic analgesia. J Clin Anesth. 2024;93:111353.
- De Cassai A, Bonanno C, Padrini R, Geraldini F, Boscolo A, Navalesi P, et al. Pharmacokinetics of lidocaine after bilateral ESP block. Reg Anesth Pain Med. 2021;46(1):86–9.
- Chin KJ, Lirk P, Hollmann MW, Schwarz SK. Mechanisms of action of fascial plane blocks: a narrative review. Reg Anesth Pain Med. 2021;46(7):618–28.
- Leong RW, Tan ESJ, Wong SN, Tan KH, Liu CW. Efficacy of erector spinae plane block for analgesia in breast surgery: a systematic review and meta-analysis. Anaesthesia. 2021;76(3):404–13.
- Lacomba MT, Del Moral OM, Zazo JLC, Gerwin RD, Goñi AZ. Incidence of myofascial pain syndrome in breast cancer surgery: a prospective study. Clin J Pain. 2010;26(4):320–5.
- Richebé P, Capdevila X, Rivat C. Persistent Postsurgical Pain: Pathophysiology and Preventative Pharmacologic Considerations. Anesthesiology. 2018;129(3):590–607.
- Kim BR, Yoon S-H, Lee H-J. Practical strategies for the prevention and management of chronic postsurgical pain. Korean J Pain. 2023;36(2):149–62.
- Schug SA, Lavand’homme P, Barke A, Korwisi B, Rief W, Treede R-D. The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain. Pain. 2019;160(1):45–52.
- Gong Y, Tan Q, Qin Q, Wei C. Prevalence of postmastectomy pain syndrome and associated risk factors: A large single-institution cohort study. Medicine (Baltimore). 2020;99(20):e19834.
- Langford DJ, Paul SM, West C, Levine JD, Hamolsky D, Elboim C, et al. Persistent Breast Pain Following Breast Cancer Surgery Is Associated With Persistent Sensory Changes, Pain Interference, and Functional Impairments. J Pain. 2014;15(12):1227–37.
- Nogueira S, Rodrigues D, Barros M, Menezes J, Guimarães-Pereira L. Chronic pain after breast surgery: incidence, risk factors and impact on quality of life. Rev Esp Anestesiol Reanim Engl Ed. 2024;71(4):274–81.
- Andersen KG, Kehlet H. Persistent Pain After Breast Cancer Treatment: A Critical Review of Risk Factors and Strategies for Prevention. J Pain. 2011;12(7):725–46.
- Meretoja TJ, Leidenius MHK, Tasmuth T, Sipilä R, Kalso E. Pain at 12 Months After Surgery for Breast Cancer. JAMA. 2014;311(1):90–2.
- De Cassai A, Bonanno C, Sandei L, Finozzi F, Carron M, Marchet A. PECS II block is associated with lower incidence of chronic pain after breast surgery. Korean J Pain. 2019;32(4):286–91.
- Versyck B, van Geffen G-J, Van Houwe P. Prospective double blind randomized placebo-controlled clinical trial of the pectoral nerves (Pecs) block type II. J Clin Anesth. 2017;40:46–50.
- Versyck B, Groen G, Kampen J, Van Houwe P. The effect of pectoral block type II on persistent pain: Follow up of a randomised trial and hypotheses for further analyses. Eur J Anaesthesiol. 2019;36(1):75–7.
- Sulak M, Ahiskalioglu A, Yayik A, Karadeniz E, Celik M, Demir U, et al. The effect of ultrasound-guided serratus plane block on the quality of life in patients undergoing modified radical mastectomy and axillary lymph node dissection: a randomized controlled study. Anaesthesiol Intensive Ther. 2022;54(1):48–55.
- Genc C, Kaya C, Bilgin S, Dost B, Ustun YB, Koksal E. Pectoserratus plane block versus erector spinae plane block for postoperative opioid consumption and acute and chronic pain after breast cancer surgery: A randomized controlled trial. J Clin Anesth. 2022;79:110691.
- Ciftci B, Altiparmak B, Tekin B, Sakul BU, Alici HA. Does ESPB performed at the level of T4 cover axillary area? A cadaveric study. J Clin Anesth. 2021;73:110362.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Anaesthesiology |
| Journal Section | Original Research |
| Authors | |
| Publication Date | June 15, 2025 |
| Submission Date | September 18, 2024 |
| Acceptance Date | April 16, 2025 |
| Published in Issue | Year 2025 Volume: 15 Issue: 2 |
