Comparison of erector spinae plane block and rhomboid intercostal block for postoperative pain management in patients undergoing unilateral breast surgery.

PURPOSE: The incidence of moderate-to-severe postoperative pain following breast surgery is approximately 50%. Effective postoperative analgesia is essential, as uncontrolled pain may increase morbidity, impair recovery, and reduce quality of life. This study aimed to compare the efficacy of the erector spinae plane block (ESPB) and rhomboid intercostal block (RIB) for postoperative pain management, based on 24-hour morphine consumption. Secondary outcomes included intraoperative opioid use, numerical rating scale (NRS) scores at rest and during movement, time to first analgesic request, and complication rates.

METHODS

Women > 18 years of age, American Society of Anesthesiologists (ASA) physical status I–III, undergoing elective unilateral breast surgery were enrolled. Exclusion criteria included lack of cooperation, chronic analgesic use, drug hypersensitivity, infection at the puncture site, spinal or paravertebral deformity, and coagulation disorders. Patients were randomized into ESPB (n = 42) or RIB (n = 42) groups using a computer-generated sequence. Thirty minutes before surgery, 20 mL 0.25% bupivacaine was administered under ultrasound guidance.

RESULTS

Data from 84 patients were analyzed. Twenty-four–hour morphine consumption did not differ significantly between groups (p > 0.05). NRS scores at 1, 3, 6, 12, and 24 h were also comparable (p > 0.05). Hemodynamic parameters and intraoperative opioid requirements showed no significant differences. Postoperative nausea and vomiting occurred in one ESPB and three RIB patients (p > 0.05). No block-related complications were observed.

CONCLUSION

Within a standardized multimodal analgesia regimen for unilateral breast surgery, ESPB and RIB yielded comparable postoperative opioid consumption and pain scores. Clinicians may therefore select either technique according to their own expertise and institutional practice.