Objective To compare the effect of erector spinae plane block (ESPB) and thoracic paravertebral block (TPVB) in radical mastectomy.
Methods Eighty women undergoing radical mastectomy surgery, aged 28-65 years, BMI < 35 kg/m2, ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups (n = 40): TPVB group and ESPB group. Before anesthesia induction, group TPVB and group ESPB received ultrasound-guided thoracic paravertebral block or erector spinae plane block, T5level, 0.5% ropivacaine 0.4 ml/kg, respectively. Then, laryngeal mask general anesthesia was conducted. Remifentanil and propofol were injected intraoperatively to maintain the anesthesia. All patients received PCIA after operation. The pain score and complications were followed up 2, 6, 12, 24, 48 h after procedure. The surgery duration, operation time of block, onset time, blocking range, puncture of pleura and vascular injury during operation, consumption of remifentanil during operation, pain NRS score at each time point after operation, PCA pressing times within 24 h, nausea, vomiting, skin itching, the occurrence of respiratory depression and other complications were recorded.
Results Compared with group TPVB, group ESPB had shorter operation time and longer onset time of nerve block, more segments involved in block plane and more PCA pressing times within 24 h (P < 0.05). No complications such as respiratory depression, puncture of pleura and vascular injury occurred in the two groups. There was no significant difference between the two groups in operation time, remifentanil consumption, pain NRS score at each time point and postoperative complication rate.
Conclusion Both erector spinal plane block and thoracic paravertebral nerve block can achieve satisfactory results in the perioperative analgesia of radical mastectomy, but compared with thoracic paravertebral nerve block, the plane block of erector spinal muscle is wider and easier to operate. |
