Erector spinae plane blocks may not provide meaningful benefit over standard analgesia in breast surgery patients

1. Erector spinae plane blocks reduced PACU opioid requirements and modestly shortened PACU stay, but did not produce a clinically meaningful reduction in total opioid consumption over 24 hours.

2. Pain control and patient satisfaction were comparable between groups, suggesting ESP blocks offer limited added analgesic benefit over standard analgesia alone in this setting.

Evidence Rating Level: 1 (Excellent) 

The erector spinae plane (ESP) block has emerged as a potentially safer alternative to the paravertebral block, the traditional gold-standard regional technique for breast surgery, given its lower risk of pneumothorax. This randomized trial compared bilateral ultrasound-guided ESP blocks (30 mL of 0.25% ropivacaine per side at T4) plus standard analgesia against standard analgesia alone in 78 patients undergoing breast reduction mammoplasty. The primary outcome assessed was cumulative opioid consumption (oral morphine milligram equivalents) over the first 24 postoperative hours. Patients receiving the ESP block had a statistically significant but clinically insignificant reduction in 24-hour opioid use (10.6 vs 17.5 MME; p=0.014). PACU discharge time was modestly shorter in the block group (170 vs 213 minutes; p=0.012), and fewer block-group patients required any opioids during PACU stay (59% vs 86.8%; p=0.006). No significant differences emerged in PACU nausea/vomiting, pain scores at discharge or at 24 hours, or overall anesthesia satisfaction.

Click here to read this study in Regional Anesthesia & Pain Medicine

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