Comparisons in Analgesic Effects Between Ultrasound-Guided Erector Spinae Plane Block and Ultrasound-Guided Modified Intercostal Nerve Block in Modified Radical Mastectomy: A Randomized Controlled Trial.

چکیده اصلی

INTRODUCTION: Postoperative acute pain is a common challenge after breast cancer surgery. This randomized controlled trial compared the analgesic effects of ultrasound-guided erector spinae plane block (ESPB) and modified intercostal nerve block (MINB) in patients undergoing unilateral modified radical mastectomy. METHODS: Seventy patients were randomly allocated to ESPB or MINB group. The primary outcomes were the 6-hour postoperative resting and movement-evoked Visual Analogue Scale (VAS) scores. Secondary outcomes included resting and movement-evoked VAS scores at 0, 3, 12, and 24 hours, intraoperative opioid consumption, rescue analgesic use within 72 hours, Quality of Recovery-15 (QoR-15) score at 24 hours, and hospital stay. RESULTS: At 6 hours postoperatively, both resting VAS (median 2 [0-2] vs 2 [2-3], P=0.005) and movement-evoked VAS (median 3 [2-4] vs 4 [3-4], P=0.015) were lower in the MINB group. Resting VAS scores at 0 and 3 hours were comparable between groups. Movement-evoked VAS scores were lower in the MINB group at all post-surgery time points (P<0.05 for all). Intraoperative remifentanil consumption was lower in the MINB group (P<0.001). Fewer patients required rescue analgesics in the MINB group (P=0.038). No significant difference was observed in QoR-15 scores between groups (P=0.055). CONCLUSION: Ultrasound-guided MINB was associated with lower 6-hour resting and movement-evoked pain scores and reduced intraoperative opioid consumption compared with ESPB, without compromising recovery quality in patients undergoing unilateral modified radical mastectomy. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2300077956; https://www.chictr.org.cn/showproj.aspx?proj=77956). Registered on November 24, 2023. Principal investigator: Guanghong Xu.

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