Erector Spinae Block vs Paravertebral Block in Breast Cancer Surgery: A Systematic Review and Meta-analysis

Rizky Rahmad Tri Cahyo, Doso Sutiyono, Intan Karmila, Ismini Aufakamilia

Abstract

 Background :The paravertebral block (PVB) is the gold standard for postoperative analgesia in breast surgery, but it easily causes pneumothorax. Erector spinae plane block (ESPB) is considered as alternative to PVB because its less invasive so relative safer. However, evidence in favor of these techniques is lacking. Method :A search of PubMed Central, Cochrane Library, Wiley Online Library, and ClinicalTrials.gov to identify the latest 20 years studies comparing ESPB and PVB in breast cancer surgery was conducted. Our endpoints were: intraoperative fentanyl consumption, total postoperative morphine, and time to first analgesic request. Result :A total of 6 studies (394 patients) were included for this meta-analysis. The pooled analysis showed there is -3.03 (MD = -3.03: 95% CI: -7.47– 1.42) mean difference with insignificant overall effect (P = 0.18) for intraoperative fentanyl consumption on ESPB patient after breast cancer surgery compared against PVB procedure. There is an insignificant between ESPB and PVB regarding total postoperative morphine with 0.46 (MD = 0.46: 95% CI: -0.94 – 1.85) mean difference with insignificant overall effect (P =0.52). There is a significant difference between ESPB and PVB regarding time to first analgesic request with 0.23(MD = 0.23: 95% CI: 0.01– 0.44) risk ratio with statistically significant overall effect (P = 0.04). Both intraoperative fentanyl consumption and total postoperative morphine consumption showed heterogeneity. Meanwhile, time to the first analgesic request showed no heterogeneity. Conclusion :Breast cancer surgery; Erector Spinae Plane Block (ESPB); Mastectomy; Paravertebral Block (PVB); Radical mastectomy.   

Keywords

Breast cancer surgery; Erector Spinae Plane Block (ESPB); Mastectomy; Paravertebral Block (PVB); Radical mastectomy.

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References

  1. Agarwal S, Bharati S, Bhatnagar S, Mishra S, Garg R, Gupta N, et al. The comparison of the efficacy of ultrasound-guided paravertebral block versus erector spinae plane block for postoperative analgesia in modified radical mastectomy: A randomized controlled trial. Saudi J Anaesth. 2021;15(2):137–43.
  2. Weng WT, Wang CJ, Li CY, Wen HW, Liu YC. Erector spinae plane block similar to paravertebral block for perioperative pain control in breast surgery: A meta-analysis study. Pain Physician. 2021;24(3):203–13.
  3. 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.
  4. Allen G. A Systematic Review and Meta-Analysis of Erector Spinae Plane Block in Breast Surgery. AORN J. 2021;114(2):193–6.
  5. Elewa AM, Faisal M, Sjöberg F, Abuelnaga ME. Comparison between erector spinae plane block and paravertebral block regarding postoperative analgesic consumption following breast surgery: a randomized controlled study. BMC Anesthesiol [Internet]. 2022;22(1):1–9. Available from: https://doi.org/10.1186/s12871-022-01724-3
  6. Gürkan Y, Aksu C, Kuş A, Yörükoğlu UH. Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: A randomized controlled trial. J Clin Anesth. 2020;59(March 2019):84–8.
  7. Huang W, Wang W, Xie W, Chen Z, Liu Y. Erector spinae plane block for postoperative analgesia in breast and thoracic surgery: A systematic review and meta-analysis. J Clin Anesth [Internet]. 2020;66(1023):109900. Available from: https://doi.org/10.1016/j.jclinane.2020.109900
  8. Xiong C, Han C, Zhao D, Peng W, Xu D, Lan Z. Postoperative analgesic effects of paravertebral block versus erector spinae plane block for thoracic and breast surgery: A meta-analysis. PLoS One [Internet]. 2021;16(8 August):1–17. Available from: http://dx.doi.org/10.1371/journal.pone.0256611
  9. El Ghamry MR, Amer AF. Original Article Role of erector spinae plane block versus paravertebral block in pain control after modified radical mastectomy. A prospective randomised trial. Indian J Anaesth. 2019;63(12):1008–14.
  10. Moustafa AM, Alabd AS, Ahmed AM, Deghidy EA. Basics of CPB. Indian J Anaesth. 2020;64(1):49–54.
  11. Wittayapairoj A, Sinthuchao N, Somintara O, Thincheelong V, Somdee W. A randomized double-blind controlled study comparing erector spinae plane block and thoracic paravertebral block for postoperative analgesia after breast surgery. Anesth Pain Med. 2022;445–53.
  12. D’Ercole F, Arora H, Kumar PA. Paravertebral Block for Thoracic Surgery. J Cardiothorac Vasc Anesth [Internet]. 2018;32(2):915–27. Available from: http://dx.doi.org/10.1053/j.jvca.2017.10.003
  13. 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.
  14. Aoyama Y, Sakura S, Tsuchiya R, Wittayapairoj A, Saito Y. Erector spinae plane block and paravertebral block for breast surgery: A retrospective propensity-matched noninferiority trial. J Pain Res. 2020;13:2367–76.

DOI: https://doi.org/10.20961/soja.v5i2.67351

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