Comparative study of Thoracic Segmental Spinal Anesthesia and Erector Spinae Plane Block for modified radical mastectomy: A randomized controlled clinical trial

This prospective randomized controlled trial compares thoracic segmental spinal anesthesia (TSSA) with erector spinae plane block (ESPB) for postoperative analgesia in patients undergoing modified radical mastectomy. Ninety ASA I and II patients aged above 18 years will be randomized into two groups: Group TSSA receiving 1.5 ml of 0.2% isobaric ropivacaine with 5 mcg dexmedetomidine at T4–T5 interspace, and Group ESPB receiving 20 ml of 0.2% ropivacaine with 0.5 mcg/kg dexmedetomidine at T5 level under ultrasound guidance. Primary outcome is postoperative pain scores measured by VAS at 30 minutes and 2 hours. Secondary outcomes include time to first analgesia, rescue analgesic requirements, and incidence of complications. Randomization uses computer-generated numbers with sealed opaque envelope concealment; outcome assessor will be blinded. Statistical analysis includes Mann-Whitney U test, unpaired t-test, and Chi-square test. The study aims to evaluate which regional technique provides superior postoperative analgesia in breast cancer surgeries.