Comparison of costotransverse block and erector spinae plane block for perioperative analgesia in patients scheduled for modified radical mastectomy - A pilot study.

BACKGROUND AND AIMS: Fascial plane blocks have emerged as a promising element for multimodal analgesia in breast surgeries. This study aimed to compare intra-operative and post-operative opioid requirements following costotransverse block (CTB) and erector spinae plane block (ESPB) for perioperative analgesia in patients scheduled for modified radical mastectomy (MRM).

METHODS

Sixty patients aged 25 to 65 years scheduled for MRM were randomised to receive either CTB or ESPB with 25 ml of 0.5% bupivacaine. The primary outcome was to compare the effectiveness of these two blocks in reducing the consumption of opioids for post-operative pain relief, measured by 24-hour morphine requirement. Secondary outcomes included time required to perform the block, intra-operative haemodynamics, total intra-operative fentanyl requirement, post-operative nausea and vomiting (PONV), and any complications related to the blocks.

RESULTS

The numeric rating scale scores were comparable between the groups at all time points during the 24-hour post-operative period. The rescue analgesic requirement (morphine), median (interquartile range) was similar in the CTB group (3 [3, 3] mg) and in the ESPB group (3 [3, 3.75] mg) (P = 1.00). The intra-operative fentanyl requirement median (interquartile range) was significantly higher in the ESPB group, 100 (100, 150) μg, than in the CTB group, 100 (100, 100) μg (P = 0.006). Incidence of PONV was comparable between the groups.

CONCLUSION

Both CTB and ESPB are comparable in providing post-operative analgesia for MRM patients. However, CTB likely offers better intra-operative analgesia as observed by the lower intra-operative opioid requirement.