الفهرس 
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Abstract
Breast surgeries are the mainstay treatment of breast cancer. It is one
of the most common surgeries due to the very high incidence of breast
cancer. The surgery is associated with a considerable post-operative pain
that constitutes a major problem for anesthetists due to complex
innervation of the breast and dissections of both thoracic and axillary
region.
Appropriate pain treatment aims to improve the results of the
surgery, reduce postoperative morbidity, decrease the incidence of chronic
postsurgical pain and decrease the duration of hospital stay.
Treatment of postoperative pain after breast surgery is based on
conventional drugs for pain relief (large doses of paracetamol, NSAID, and
oral or intravenous opioid). This is associated with adverse effects, such as
nausea, sedation, hypotension and increased cardiac load. All these effects
delay rehabilitation, overall recovery and discharge.
Here the role of the regional block appears to overcome these side
effects for the management of acute postoperative pain in breast surgeries.
Recently, ultrasound-guided technique regional block has been used
successfully to avoid the problems of the blind technique and provided
better control of a variety of postoperative pain.
The erector spinae plane (ESP) block is a safe, simple and effective
regional anesthesia technique that can be used to provide analgesia for a
variety of surgical procedures.
Regarding breast surgeries, it is considered a safe alternative to the
paravertebral block, which is a particularly challenging technique because
of the anatomic proximity of the pleura and central neuraxial system.
The aim of our study was to evaluate the efficacy of the ultrasound
guided erector spinae plane block as a postoperative analgesia in elective
unilateral breast surgery.
This study was conducted on 60 female patients aged ≥ 20 to ≤ 60
years old, ASA physical status I_II who were scheduled for elective
unilateral breast surgery. Patients were randomized into two groups, 30
Patients in each group.
group 1: (Control group)
Patients received only general anesthesia.
group 2: (Erector spinae plane block group)
Patients received US-guided ESP block with 20 ml of 0.25%
bupivacaine and 8mg. dexamethasone as a local anesthetic adjuvant after
general anesthesia.
Parameters of assessment were
Static and dynamic Postoperative pain was assessed using a visual
analogue scale (VAS) every 2hrs for the 1st 8hrs and every 8hrs for
the remaining 24 hrs. post-operatively.
total morphine and paracetamol consumption during the 24-h
postoperative period.
time to the first request for rescue analgesia (when VRS was 4 or
more).
Perioperative hemodynamics (HR- MAP).
Incidence of postoperative complications.
The main results were as follow
Both groups were comparable regarding the demographic data and
the type of surgery.
ESPB group showed a significantly lower VASstatic score than the
control group at 0 time (half an hour after recovery), 2h, and 4h
postoperatively (p<0.001). Also, the VASdynamic score was
significantly lower in the ESPB group than in the control group at 0
time, 2h, 4h, and 6h postoperatively (p<0.001).
The time until the first required analgesia was significantly longer in
ESPB group than the control group (5(3-6) vs. 0.5(0.5-0.5) in hours,
respectively; with p<0.001); while the post-operative 24h morphine consumption was significantly lower in ESPB group than the control
group (2.30± 2.18 mg vs.10.10± 3.56 mg, respectively; with
P<0.001). Similarly, the frequency of paracetamol (1gm) intake was
significantly lower in ESPB group than in the control group
(P<0.001).