Comparison of ESP and SPSIP Blocks in Breast Surgery
- Conditions
- Breast SurgeryMacromastiaMammaplastyModified Radical MastectomyMammary CancerBreast Implant
- Interventions
- Other: Erector Spinae Plane BlockOther: SPSIPB blcokOther: Control
- Registration Number
- NCT06611644
- Lead Sponsor
- Çanakkale Onsekiz Mart University
- Brief Summary
This study aims to compare the efficacy of the ESP and SPSIP blocks in managing postoperative pain following breast surgery. Breast surgery, particularly after oncological and reconstructive procedures, often leads to significant postoperative pain. Effective pain control is crucial for accelerating recovery, reducing the risk of complications, and facilitating early discharge. Both ESP and SPSIP blocks involve the administration of local anesthetics into fascial plane spaces to achieve peripheral nerve blockade and control pain. This study will evaluate the effectiveness of these blocks in terms of pain scores, opioid consumption, and overall patient satisfaction to determine the optimal approach for postoperative pain management in breast surgery.
- Detailed Description
Breast surgery is one of the most frequently performed procedures, and effective postoperative pain management is critical to its success. Proper pain control not only facilitates early mobilization but also reduces the risks of pulmonary complications, deep vein thrombosis, and embolism. It helps prevent stress-induced endocrine and metabolic responses, shortens hospital stays, and lowers healthcare costs. Regional anesthesia is a highly effective strategy for postoperative pain control, minimizing opioid use and its associated side effects such as sedation, nausea, vomiting, and constipation.
Among the commonly used regional anesthesia techniques in breast surgery are the Erector Spinae Plane (ESP) block, Serratus Anterior Plane block, and Pectoral block. While the ESP block appears more effective, conflicting evidence exists regarding its efficacy in postoperative pain management, with variability in block spread across individuals. The recently introduced Serratus Posterior Superior Intercostal Plane (SPSIP) block, a periparavertebral block, offers a wider distribution range from C3 to T7 dermatomes, suggesting potential for more comprehensive postoperative analgesia in breast procedures.
The ESP block is performed under ultrasound guidance, using an in-plane technique to advance the needle from caudal to cranial (or vice versa), targeting the lateral part of the T6 transverse process, where local anesthetic is injected between the erector spinae muscle and the transverse process. For the SPSIP block, the needle is advanced between the second and third ribs towards the medial scapula, reaching the fascial plane between the serratus posterior superior muscle and the intercostal muscles. After hydrodissection confirms placement, local anesthetic is injected.
This study aims to compare the efficacy of ESP and SPSIP blocks in managing postoperative pain in breast surgery by evaluating pain scores, opioid consumption, and patient satisfaction. Since no study has yet directly compared these blocks, the findings will make a significant contribution to the existing literature.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 75
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Erector Spinae Plane (ESP) block group Erector Spinae Plane Block This group will include patients who undergo the Erector Spinae Plane (ESP) block. The ESP block will be performed under ultrasound guidance, with a needle placed on the transverse process of the vertebra to inject local anesthetic into the erector spinae muscle. Serratus Posterior Superior Intercostal Plane (SPSIP) block SPSIPB blcok This group will include patients who undergo the Serratus Posterior Superior Intercostal Plane (SPSIP) block. The SPSIP block will be performed under ultrasound guidance, injecting local anesthetic into the plane between the serratus posterior superior muscle and the intercostal muscles. Control Group Control Patients in this group will receive standard postoperative pain management. This management will be provided through systemic analgesics (e.g., paracetamol, nonsteroidal anti-inflammatory drugs, and opioids if necessary) based on the patient's pain level during the postoperative period. This group will consist of patients who do not receive regional blocks, and pain management will be conducted according to the standard procedure of the surgery.
- Primary Outcome Measures
Name Time Method Postoperative Opioid Consumption 24 hours Postoperative opioid consumption will be monitored using a Patient-Controlled Analgesia (PCA) device, which will be connected to each patient at the end of surgery. The PCA settings will be 2 mg/cc tramadol solution, with no basal infusion, a lockout time of 20 minutes, and a 10 mg bolus dose. The total opioid (tramadol, Unit: miligram) consumption over 24 hours will be recorded, including the number of times the patient required analgesia and the number of bolus doses administered by the device.
Numeric Rating Scale (NRS) 24 hours postoperatively (measured at 0, 2, 6, 12, and 24 hours) Pain intensity will be assessed using the Numeric Rating Scale (NRS), where patients rate their pain on a scale from 0 (no pain) to 10 (worst possible pain). NRS scores will be recorded to evaluate postoperative pain levels in each group at specific intervals.
- Secondary Outcome Measures
Name Time Method Verbal Descriptive Nausea and Vomiting Scale 24 hours postoperatively (measured at 0, 2, 6, 12, and 24 hours) Postoperative nausea and vomiting will be recorded for each patient at 0, 2, 6, 12, and 24 hours after surgery. The presence and severity of nausea and vomiting will be assessed using the Verbal Descriptive Nausea and Vomiting Scale, where 0 = none, 1 = mild nausea, 2 = moderate nausea, 3 = vomiting once, and 4 = vomiting more than once. This outcome will allow for a comparison of the potential of each technique to trigger postoperative nausea and vomiting.
Patient Satisfaction 24 hours postoperatively Postoperative patient satisfaction will be measured to assess the overall acceptance and comfort related to the pain management strategies. Patient satisfaction will be rated on a three-point scale: good, moderate, or poor. This outcome will reflect the effectiveness of the pain management techniques in terms of patient comfort and overall experience.
Length of Hospital Stay Up to 1 week postoperatively (measured in hours) The length of hospital stay (measured in hours) will be recorded for each patient to evaluate the potential for early discharge. A shorter hospital stay is typically associated with better pain management and faster recovery. This outcome will help assess the effectiveness of the pain control strategies in facilitating quicker recovery and discharge.
Trial Locations
- Locations (1)
Canakkale Onsekiz Mart University
🇹🇷Canakkale, Turkey