1. In a cohort of patients undergoing breast surgery, erector spinae plane block improved the quality of recovery compared to the control.
Evidence Rating Level: 1 (Excellent)
Regional anesthesia techniques are commonly used for breast surgery. The erector spinae plane block is a newer technique for delivering regional anesthesia to patients undergoing breast surgery. It has proven to reduce pain severity and opioid consumptions. However, there is a lack of data with regards to the quality of recovery in patients following this procedure. Therefore, this randomized control trial aimed to evaluate the quality of recovery in patients undergoing breast surgery receiving the procedure. It analyzed data from 65 patients who were randomized into either the control group (n=22), the sham block group (n=21) or the erector spinae plane (ESP) group (n=22). All patients were anesthetized in the same manner. Patients in the ESP group received a block at the level of T2 using 0.375% solution of ropivacaine at 0.4 mL/kg. Patients in the sham group were injected with 0.4 mL/kg of normal saline. The control group did not receive any further intervention beyond the general anesthesia. The primary outcome measured was the assessment of the patient’s improvement with quality of recovery (QoR)-40 a day after surgery. The study found that patients in the ESP group had improved QoR-40 compared to the control group (mean [interquartile range], 186 [177–193] vs. 175 [165–183]). The secondary outcomes measured were postoperative pain evaluation on the visual analog scale, 24-hour opioid consumption, time to the first opioid demand, and global satisfaction with preoperative treatment. It was found that acute postoperative pain severity was higher in the control group compared to the ESP group at postoperative hour 2 (p=0.012) and 4 (p<0.01). The study also found that postoperative oxycodone consumption was significantly higher in the control group compared to the ESP group. Patient satisfaction was also found to be higher in the ESP group compared to the control group. Finally, it was found that patients in the ESP group required their first dose of opioids significantly later compared to participants in the control group (3.65 [1.18–8.93] vs. 0.98 [0.61–2.81] hour; p = 0.014). Overall, the study concluded that The ESP block is superior to the control in terms of quality of recovery in patients undergoing breast surgery. However, additional randomized control trials with larger sample sizes are needed to further validate the results of this study.
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