Ultrasound guided erector spinae plane block versus retrolaminar block for post operative analgesia in patients under going modified radical mastectomy- a randomised controlled trial

Breast cancer is the most common cancer among women in India accounting for 32% of all women cancers.  The incidence is 35 per 100,000 women with 75000 new cases diagnosed and 40,000 deaths per year. Most commonly the surgical approach of choice is  Modified Radical Mastectomy (MRM),  due to it allowing for both the removal of the main tumor  mass and adjacent glandular tissue, which are suspected of infiltration and multifocality of the  process, and a sentinel axillary lymph node removal.(1) Acute pain after breast surgery may lead to the development of chronic persistent pain in women undergoing such procedures.  Blocking the nociceptive inputs through the intercostal nerves is important for the postoperative pain control after breast surgery, because cutaneous innervation of the breast is mainly derived from the intercostal nerves, along with supraclavicular nerves.(2)  Thoracic paravertebral block (TPVB) is widely used for providing post operative analgesia after breast surgery . This technique is having risk of   development of pneumothorax.(3) Erector Spinae Block targets the transverse process and mechanism of action is by spread of local anaesthetics into the paravertebral space and intercostal space. The Retrolaminar Block target lamina of vertebra and mechanism is by spread of local anaesthetic into the paravertebral space.(4)  So Retrolaminar Block and Erector Spinae Plane block are easier and safer alternative techniques to TPVB .