Effects of erector spinae plane block on postoperative pain in patients undergoing implant-based breast reconstruction for breast cancer: a randomized controlled trial.
ESPB may reduce opioid use and improve early recovery after breast reconstruction, but its clinical significance in pain reduction is uncertain.
Where it sits
this study against the rest of the melanotan 1 corpusSummary and findings
This randomized controlled trial evaluated the effect of a single-shot T5 erector spinae plane block (ESPB) on postoperative pain in 100 adults undergoing implant-based breast reconstruction. The ESPB group received 30 mL of 0.375% ropivacaine plus dexmedetomidine 1 μg/kg. ESPB reduced opioid use and improved early recovery, but the clinical significance of pain reduction remains uncertain.
Abstract
<h4>Background</h4>Implant-based breast reconstruction after mastectomy causes acute pain.<h4>Objective</h4>To determine whether a single-shot T5 erector spinae plane block (ESPB) reduces postoperative pain.<h4>Design</h4>Single-center, RCT with allocation concealment; blinded assessors and statisticians.<h4>Setting</h4>Tertiary cancer center in China.<h4>Patients</h4>100 adults scheduled for radical mastectomy with implant reconstruction were randomized (1:1); follow-up complete.<h4>Intervention</h4>Before induction, ESPB was given under ultrasound guidance at T5 with 30 mL of 0.375% ropivacaine plus dexmedetomidine 1 μg/kg; controls received no block. Standardized general anesthesia and postoperative PCA for both groups.<h4>Main outcome measures</h4>Resting NRS at 6 h (MCID=1). Secondary outcomes were opioid consumption, quality of recovery, and PONV.<h4>Results</h4>ESPB did not significantly reduce resting pain at 6 h at the median (τ =0.50; adjusted difference -0.9; <i>p</i> = 0.08). At the upper tail, pain intensity was lower (τ = 0.75; -1.8; <i>p</i> <0.01). Repeated measures provided additional time-point information, improving estimation precision and test sensitivity. ESPB get lower pain scores at 6, 12, and 24 hours (all <i>p</i> <0.01). But, the 95% CI includes the MCID, the clinical benefit remains uncertain. Opioid use decreased at 24 h (-13.5 mg; <i>p</i> <0.01) and 48 h (-6.6 mg; <i>p</i> <0.01). Quality of recovery improved at 24 h (difference 5 points; <i>p</i> <0.01), but not later. No differences were observed in intraoperative hemodynamics or PONV.<h4>Conclusions</h4>Single-shot T5 ESPB with perineural dexmedetomidine may reduce postoperative pain and opioid requirements and improve early recovery. Further large trials are warranted. Clinical relevance remains to be confirmed.<h4>Trial registration</h4>ClinicalTrials.gov NCT06143020.
Background
This study addresses the management of acute postoperative pain in patients undergoing implant-based breast reconstruction after mastectomy. Previous approaches have sought to minimize opioid use and improve recovery, but the effectiveness of regional anesthesia techniques like the erector spinae plane block (ESPB) in this context is not well established. This study aims to provide evidence on the efficacy of ESPB in reducing pain and opioid consumption.
Methods
The study was a single-center, randomized controlled trial conducted at a tertiary cancer center in China. It included 100 adults scheduled for radical mastectomy with implant reconstruction, randomized in a 1:1 ratio. The intervention group received a single-shot T5 ESPB with 30 mL of 0.375% ropivacaine plus dexmedetomidine 1 μg/kg under ultrasound guidance before induction. The control group did not receive the block. Both groups received standardized general anesthesia and postoperative PCA. The primary outcome was resting NRS at 6 hours, with secondary outcomes including opioid consumption, quality of recovery, and PONV.
Results
The ESPB did not significantly reduce resting pain at 6 hours at the median (adjusted difference -0.9; p = 0.08), but pain intensity was lower at the upper tail (τ = 0.75; -1.8; p < 0.01). Pain scores were lower at 6, 12, and 24 hours (all p < 0.01), though the 95% CI includes the MCID, making clinical benefit uncertain. Opioid use decreased at 24 hours (-13.5 mg; p < 0.01) and 48 hours (-6.6 mg; p < 0.01). Quality of recovery improved at 24 hours (difference 5 points; p < 0.01), but not at later time points. No differences were observed in intraoperative hemodynamics or PONV.
Interpretation
While the ESPB showed statistically significant reductions in pain scores and opioid use, the clinical significance of these findings is unclear due to the inclusion of the MCID within the 95% CI. The improvements in early recovery are promising, but the lack of sustained benefits and the single-center design limit generalizability. Larger trials are needed to confirm these findings and establish clinical relevance.
Key findings
- Resting NRS at 6 h: adjusted difference -0.9; p = 0.08
- Pain intensity lower at upper tail: τ = 0.75; -1.8; p < 0.01
- Opioid use decreased at 24 h: -13.5 mg; p < 0.01
- Opioid use decreased at 48 h: -6.6 mg; p < 0.01
- Quality of recovery improved at 24 h: difference 5 points; p < 0.01
Limitations
- Single-center study
- Relatively small sample size (n=100)
- 95% CI includes MCID, clinical benefit uncertain
- Short follow-up for recovery outcomes