Erector Spinae Plane (ESP) block in breast surgery
- Conditions
- Malignant neoplasm of breast of unspecified site,
- Registration Number
- CTRI/2018/11/016389
- Lead Sponsor
- AIIMS New Delhi
- Brief Summary
Erectorspinae plane (ESP) block is a recently described ultrasound guided techniquewhereby injecting a local anaesthetic (LA) above or below the erector spinae musclesat the level of 5th thoracic (T5) transverse process produced asensory blockade from T2 to T9 vertebral levels in cephalocaudad direction andfrom a line 3 cm lateral to thoracic spine to mid-clavicular line inanterior-posterior direction in a patient with thoracic neuropathic pain (15).The axilla and medial aspect of the upper arm also exhibited sensory blockade.The contrast study on the cadaver demonstrates the spread of dye to the immediatevicinity of ventral and dorsal rami of spinal nerve roots (15). The erector spinae muscle extends along the length of the thoracolumbarspine, and thus, this plane permits extensive cranio-caudal spread and coverageof multiple dermatomes. The most significant advantage of the ESP block is itssimplicity and safety. The sonoanatomy is easily recognizable, and there are nostructures at risk of needle injury in the immediate vicinity. The techniquealso lends itself well to insertion of an indwelling catheter, which can beused to extend the duration of analgesia as needed.
Several case reports described the efficacy of ESPblock and found to be superior in treating visceral pain and neuropathic painconditions. ESP block performed at the level of T5 transverse process is successfully used to treat severeneuropathic pain in thoracic region in two cases (15). BilateralESP block done at the level of T7 vertebral level produced good visceral analgesiafor patient undergoing laparoscopic mesh repair for ventral hernia (16), and painassociated with bariatric surgery (17). The technique has been successfullyused to treat pain associated with multiple rib fractures (18), thoracicvertebra surgery (19), and oncologic thoracic surgery in children (20).
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Not Yet Recruiting
- Sex
- Female
- Target Recruitment
- 60
- Female patients undergoing elective unilateral breast surgeries with or without axillary clearance.
- Aged between 18-65 year of age ASA (American Society of Anesthesiology) Physical status I and II patients.
- Patients refusal to participate in the study History of coagulation disorders, antiplatelet therapy, anticoagulant therapy.
- Morbid obesity with BMI ≥35kg/m2 Thoracic vertebral anomalies and severe chest wall deformity Known allergy to study drugs Patients with infection at the site of proposed block Pregnancy Severe cardiac, renal and hepatic conditions Thyrotoxicosis Mental retardation.
Study & Design
- Study Type
- Interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method To compare the duration of analgesia produced by three regional anaesthetic techniques (ESP, TPVB and SAP blocks) in patients undergoing any breast surgery under general anaesthesia. immediate post operative period (0 hour) | Then at 1st, 2nd, 4th, 6th, 12th, 18th and 24th hour of surgery
- Secondary Outcome Measures
Name Time Method Secondary Objectives 1.To compare the total rescue opioid or opioid equivalent drugs required in the first 24 hours after surgery.
Trial Locations
- Locations (1)
AIIMS New Delhi
🇮🇳South, DELHI, India
AIIMS New Delhi🇮🇳South, DELHI, IndiaDr Praveen TalawarPrincipal investigator9654162941praveenrt64@gmail.com