scholarly journals The Effect of Preoperative Ultrasound-Guided Erector Spinae Plane Block on Chronic Postsurgical Pain After Breast Cancer Surgery: A Propensity Score-Matched Cohort Study

2021 ◽  
Author(s):  
Ling Xin ◽  
Ning Hou ◽  
Ziyan Zhang ◽  
Yi Feng
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Propensity Score ◽  
Cancer Surgery ◽  
Erector Spinae ◽  
Breast Cancer Surgery ◽  
Matched Cohort ◽  
Ultrasound Guided ◽  
Erector Spinae Plane Block ◽  
Chronic Postsurgical Pain

scholarly journals Analgesic efficacy and safety of erector spinae plane block in breast cancer surgery: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying Zhang ◽  
Tieshuai Liu ◽  
Youfa Zhou ◽  
Yijin Yu ◽  
Gang Chen
Keyword(s):  
Breast Cancer ◽  
Meta Analysis ◽  
Analgesic Efficacy ◽  
Cancer Surgery ◽  
Opioid Consumption ◽  
Erector Spinae ◽  
Breast Cancer Surgery ◽  
Rescue Analgesia ◽  
Erector Spinae Plane Block ◽  
Pain Scores

Abstract Background Surgical resection is considered to be the primary and most effective therapy for breast cancer, postoperative pain is an issue gaining significant attention. In recent years, erector spinae plane block (ESPB) has attracted much attention in postoperative analgesia, but its effectiveness is still controversial. This meta-analysis was implemented to verify the clinical analgesic efficacy and safety of erector spinae plane block in patients undergoing breast cancer surgery. Methods We searched PubMed, EMBASE, Web of Science, the Cochrane Library and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing ESPB with general anesthesia (GA) in breast cancer surgery that were published before December 25, 2020. The primary outcome was opioid consumption at the first 24 h after surgery, while secondary outcomes included pain scores at 1, 6,12 and 24 h after surgery, opioid consumption at 1, 6 and 12 h after surgery, intraoperative opioid consumption, number of patients who need for rescue analgesia, and the incidence of postoperative nausea and vomiting (PONV). Results Eleven randomized controlled trials involving 679 patients met the study inclusion criteria and were included in this study. In comparison to GA group, the ESPB group showed a significant reduction in morphine consumption at the first 24 h after surgery by a mean difference (MD) of − 7.67 mg [95% confidence interval (CI) − 10.35 to − 5.00] (P <  0.01). In addition, the ESPB group showed lower pain scores than the GA group in the four time periods (1, 6, 12 and 24 h after surgery). ESPB group significantly reduce the intraoperative consumption of fentanyl, the need for postoperative rescue analgesia, and the incidence of PONV. Conclusions Ultrasound-guided ESPB is an effective approach for reducing morphine consumption and pain intensity within the first 24 h after breast cancer surgery, compared with GA alone.

scholarly journals Statistically significant but clinically unimportant: a systematic review and meta-analysis of the analgesic benefits of erector spinae plane block following breast cancer surgery

2020 ◽  
Vol 46 (1) ◽  
pp. 3-12 ◽  
Author(s):  
Nasir Hussain ◽  
Richard Brull ◽  
Jordan Noble ◽  
Tristan Weaver ◽  
Michael Essandoh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Meta Analysis ◽  
Oral Morphine ◽  
Cancer Surgery ◽  
Erector Spinae ◽  
Breast Cancer Surgery ◽  
Short Term ◽  
Erector Spinae Plane Block ◽  
Quality Evidence

The novel erector spinae plane block (ESPB) has been reported to provide important postoperative analgesic benefits following a variety of truncal and abdominal surgical procedures. However, evidence of its analgesic efficacy following breast cancer surgery, compared with parenteral analgesia, is unclear. This meta-analysis evaluates the analgesic benefits of adding ESPB to parenteral analgesia following breast cancer surgery.Databases were searched for breast tumor resection trials comparing ESPB to parenteral analgesia. The two co-primary outcomes examined were 24-hour postoperative oral morphine equivalent consumption and area-under-curve of rest pain scores. We considered reductions equivalent to 3.3 cm.h and 30 mg oral morphine in the first 24 hours postoperatively for the two co-primary outcomes, respectively, to be clinically important. We also assessed opioid-related side effects and long-term outcomes, including health-related quality of life, persistent postsurgical pain and opioid dependence. Results were pooled using random effects modeling.Twelve trials (699 patients) were analyzed. Moderate quality evidence suggested that ESPB decreased 24-hour morphine consumption and area-under-curve of rest pain by a mean difference (95% CI) of −17.60 mg (−24.27 to −10.93) and -2.74 cm.h (−3.09 to −2.39), respectively; but these differences were not clinically important. High-quality evidence suggested that ESPB decreased opioid-related side effects compared with parenteral analgesia by an OR (95% CI) of 0.43 (0.28 to 0.66). None of the studies evaluated long-term block benefits.Adding ESPB to parenteral analgesia provides statistically significant but clinically unimportant short-term benefits following breast cancer surgery. Current evidence does not support routine use of ESPB. Given the very modest short-term benefits and risk of complications, the block should be considered on a case-by-case basis.

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