الفهرس 
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Abstract
Breast surgeries are common surgical procedures especially breast cancer surgeries, particularly in middle-aged women. US-guided ESP block has become a recognizable peripheral nerve plane block for regional analgesia in thoracic surgeries.
This prospective randomized comparative clinical study was conducted in a total of 40 female patients, aged 18- 65-year-old, with the ASA physical status I–II, enrolled for unilateral elective breast cancer surgery without axillary clearance, randomized into two groups 20 patients each allocated to receive either single-shot TE Analgesia; TE group, or US-guided single shot ESP block; ESP group, then they were followed up for 24 hours postoperatively and the results were analyzed. The primary outcome was to compare the intra- and post-operative analgesic effect of ESP block with TE. The secondary outcomes were to compare hemodynamic changes and any complications related to the techniques or drugs used, and patient satisfaction.
In the ESP group, the patient was positioned in a lateral decubitus with the side to be blocked upwards. The block was performed using US-guided high frequency linear probe at T4 of the spine where 20 ml of 0.25% bupivacaine administered. An LA is dripped deep to the ESM and superficial to the tip of the TP at the myofascial plane. The instilled LA induced sensory block at the multi-dermatomal levels across the posterior, lateral, and anterior thoracic wall.
In TE group, the patient was positioned in a lateral position also as in ESP group, an 18-gauge Tuohy needle was inserted in the posterior midline at the level of T4-5 where 10 ml of bupivacaine 0.25 % were injected once.
After interpretation of our results, as regards narcotic consumption; intraoperative fentanyl consumption was significantly higher in ESP group, post-operative morphine consumption in PACU was not statistically different between the groups, while pethidine consumption in the surgical ward was higher in TE group. Concerning pain assessment, VAS scores in ESP group were statistically lower when compared with TE group starting from 2 hours till 12 hours postoperatively, and higher in patients’ satisfaction about analgesia in the first 24 hours postoperatively. As regards hemodynamic effects; TE group showed lower MAP recordings with significant difference between the ESP group at 10 min., 30 min. and 1 hr. after the intervention, TE group showed significant difference with lower HR recordings in comparison to ESP group; at 30 min after the block.
Intragroup comparison of MAP and HR in the two groups over time revealed that there were no statistically significant differences over time in ESP group regarding MAP, while there were significant differences over time in ESP group regarding HR, and in TE group regarding both MAP and HR.
No complications related to the techniques, or the drugs used reported in the study.
Postoperatively, results of our study point out to the efficacy of ESP block in providing effective analgesia after breast cancer surgeries. This efficacy was shown in the form of significantly lower consumption of pethidine and significantly lower VAS scores, the duration of analgesia which was long enough postoperatively to up to 12 hours when compared with TE.
We propose that ESP block should be included in the armamentarium of regional anesthetic techniques in the daily anesthesia clinical practice.