الفهرس 
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Abstract
Breast cancer is the most common cancer among women all over the world. Acute Postoperative pain is an integrated risk factor for the development of chronic post-mastectomy pain where 40% of women after breast cancer surgery will have severe acute Postoperative pain and 50% will develop chronic post-mastectomy pain with impaired quality of life. Analgesic modalities after breast surgery are often challenging as many breast surgeries are performed as one day case surgery. Many modalities can be integrated as a part of anesthesia or analgesia in breast cancer surgeries such as thoracic paravertebral blockade, intercostal nerve blockade, thoracic epidural blockade and wound infiltration. Gold standard techniques that have been appeared to give superior analgesia include thoracic epidural and paravertebral blocks. Cancer recurrence rates and chronic post-mastectomy pain are diminished with the utilization of these techniques for analgesia. In 2016, Forero et al. described a new less invasive ultrasound-guided technique, the erector spinae plane block (ESPB). It was showed that ESPB can be considered as easy, fast and safe to perform the alternative analgesic technique to thoracic paravertebral block in modified radical mastectomy. Additionally, ESPB provided superior analgesia with delayed first analgesic request and lower number of patients requiring Postoperative analgesia. Also, visual analogue scale (VAS) was significantly lower with the ESPB. We tried to compare and evaluate the efficiency of different volumes and equivalent concentrations of isobaric bupivacaine 0.25% in ESPB in reducing the Postoperative pain after modified radical mastectomy surgeries under general anesthesia. Patients were randomly allocated to one of two groups (convenient sample of 30 patients each) using the closed envelope method:- 1. Erector spinae plane block with 10 ml of 0.25% isobaric bupivacaine (group V 10). 2. Erector spinae plane block with 20 ml of 0.25% isobaric bupivacaine (group V 20). Our study revealed that the use of 20 ml of 0.25% isobaric bupivacaine in ultrasound-guided erector spinae plane block in modified radical mastectomy surgery prolonged the Postoperative analgesia, delayed time of first analgesic request and reduced Postoperative opioid consumption compared to use of 10 ml 0.25% isobaric bupivacaine. Postoperative nausea and vomiting in V 20 group were lower than V 10 group that may be due to the lower total opioid consumption in V 20 group.