Journal of Advanced Research in Health Sciences 2651-4060 Istanbul University 10.26650/JARHS2023-1215655 Clinical Sciences Klinik Tıp Bilimleri REDÜKSİYON MAMOPLASTİ AMELİYATLARINDA TORASİK PARAVERTEBRAL BLOK İLE EREKTOR SPİN PLAN BLOĞUNUN PERİOPERATİF ANALJEZİK SONUÇLARININ KARŞILAŞTIRILMASI: RETROSPEKTİF KOHORT ÇALIŞMA COMPARISON OF THE PERIOPERATIVE ANALGESIC OUTCOMES OF THORACIC PARAVERTEBRAL BLOCK VERSUS ERECTOR SPINAE PLANE BLOCK IN REDUCTION MAMMAPLASTY SURGERIES: A RETROSPECTIVE COHORT STUDY https://orcid.org/0000-0002-8662-5380 Bingül Emre Sertaç Istanbul Faculty of Medicine, Department of Anesthesiology and Reanimation https://orcid.org/0000-0002-8170-6827 Salvız Emıne Aysu Washington University, School of Medicine, Department of Anesthesiology, St. Louis https://orcid.org/0000-0003-3489-6944 Canbaz Mert Istanbul University, Istanbul Faculty of Medicine, Department of Anesthesiology and Reanimation https://orcid.org/0000-0002-0838-9976 Güzel Mehmet Istanbul University, Istanbul Faculty of Medicine, Department of Anesthesiology and Reanimation https://orcid.org/0000-0003-1192-9520 Kozanoğlu Erol Istanbul University, Istanbul Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery https://orcid.org/0000-0002-5663-1026 Karadeniz Meltem Istanbul University, Istanbul Faculty of Medicine, Department of Anesthesiology and Reanimation 06 26 2023 6 2 129 135 12 07 2022 12 28 2022 Copyright © 2018, Journal of Advanced Research in Health Sciences 2018 Journal of Advanced Research in Health Sciences

Amaç: Torasik paravertebral blok (TPVB) ve Erektor spina plan bloğu (ESPB) meme ameliyatlarında en çok tercih edilen rejyonal analjezi tekniklerindendir. Literatürde bu iki bloğun birbirine üstünlüğünü gösteren güvenilir kanıtlar kısıtlıdır. Hipotezimizi TPVB’nin akut postoperatif dönemde daha iyi analjezi sağlayacağı yönünde kurduk.Gereç ve Yöntem: Bu retrospektif kohort çalışmada bilateral redüksiyon mamoplasti uygulanan hastalar genel anestezi öncesinde uygulanmış olan rejyonal tekniğe göre (bilateral TPVB veya ESPB, %0,375 bupivakain ile) gruplandırıldı. Ameliyat öncesi (Blok sonrası 10. dakika, 20. dakika ve 30. dakika) ve ameliyat sonrası 0. dakika, 1. saat, 2. saat, 4. saat, 6. saat, 12. saat, 24. saat ve 48. saatte duyu bloğu oluşmuş dermatom sayısı ve postoperatif ağrı skorları tarandı. İntraoperatif ve postoperatif verilen analjezik miktarı, ağrının ilk ortaya çıkışı süresi, bulantı-kusma (POBK) insidansı, uyku süresi, komplikasyonlar ve hasta/cerrah memnuniyet skorları gibi konfor parametreleri araştırıldı. Bulgular: Toplam 58 hasta tarandı. Postoperatif ilk 2 saat ağrı skorları TPVB grubunda daha düşüktü (p<0,05). TPVB, postoperatif 1. günde daha fazla dermatomu bloke ederken (p<0,05), postoperatif tramadol tüketimi her iki blokta benzerdi (p>0,05). Postoperatif 2. gün parasetamol tüketimi ise TPVB ile daha azdı (p=0,03). Postoperatif 1. gün ilk ağrı süresi ve uyku süresi ESPB ile daha kısaydı (p<0,05). Sonuç: Redüksiyon mamoplasti için torasik paravertebral blok, erektor spina plan bloğundan daha etkili analjezik özellikler göstermektedir. Bununla birlikte, ESPB yeterli analjezi sağlanmasında faydalıdır.

Objective: Thoracic paravertebral block (TPVB) and Erector spinae plane block (ESPB) are the most preferred regional analgesia techniques for breast surgeries. However, the literature is still lack of reliable evidence to prove superiority of one over another. We hypothesized that TPVB would provide better pain control for the acute postoperative period. Material and Methods: In this retrospective cohort study, macromastia patients who underwent bilateral reduction mammaplasty surgery were grouped according to the regional technique performed prior to general anesthesia induction that are provided with 0.375% bupivacaine bilaterally (TPVB or ESPB). Presurgery (10th min, 20th min, and 30th min) and postoperative number of dermatomal sensory block, and postoperative pain scores were screened which referred to postoperative 0 minute,1st hour, 2nd hour, 4th hour, 6th hour, 12th hour, 24th hour and 48th hour examination. Intraoperative and postoperative analgesic administration, and comfort parameters such as time-to-first pain, nausea-vomiting (PONV) incidence, sleep duration, complications and patient/surgeon satisfaction scores were also investigated. Results: Total 58 patients were screened. Pain scores were lower in TPVB group for the postoperative first 2 hours (P<0.05). TPVB blocked more dermatomes during postoperative 1st day (P<0.05) whereas postoperative tramadol consumption were similar with both blocks (P>0.05). On the other hand, postoperative 2nd day paracetamol consumption was less with TPVB (P=0.03). Time-to-first pain and sleep duration on the postoperative 1st day was shorter with ESPB (P<0.05). Conclusions: Thoracic paravertebral block represents better analgesic features than erector spinae plane block for reduction mammaplasty. However, ESPB may still be considered to provide favorable analgesia.

 Thoracic paravertebral block erector spinae plane block macromastia reduction mammoplasty thoracic wall block acute pain nerve block regional anesthesia Torasik paravertebral blok erektor spina plan bloğu makromasti redüksiyon mamoplasti torasik duvar bloğu akut ağrı sinir bloğu rejyonal anestezi Saadawi M, Layera S, Aliste J, Bravo D, Leurcharusmee P, Tran Q. Erector spinae plane block: A narrative review with systematic analysis of the evidence pertaining to clinical indications and alternative truncal blocks. J Clin Anesth 2021;68:110063. google scholar Chin KJ. Thoracic wall blocks: From paravertebral to retrolaminar to serratus to erector spinae and back again - A review of evidence. Best Pract Res Clin Anaesthesiol 2019;33(1):67-77. google scholar Helander EM, Webb MP, Kendrick J, Montet T, Kaye AJ, Cornett EM, et al. PECS, serratus plane, erector spinae, and paravertebral blocks: A comprehensive review. Best Pract Res Clin Anaesthesiol 2019;33(4):573-81. google scholar Chin KJ, Versyck B, Pawa A. Ultrasound-guided fascial plane blocks of the chest wall: a state-of-the-art review. Anaesthesia 2021;76 Suppl 1:110-26. google scholar Swisher MW, Wallace AM, Sztain JF, Said ET, Khatibi B, Abanobi M, et al. Erector spinae plane versus paravertebral nerve blocks for postoperative analgesia after breast surgery: a randomized clinical trial. Reg Anesth Pain Med 2020;45(4):260-6. google scholar Gurkan Y, Aksu C, Kus A, Yorukoglu UH. Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: A randomized controlled trial. J Clin Anesth 2020;59:84-8. google scholar Hussain N, Brull R, Noble J, Weaver T, Essandoh M, McCartney CJ, et al. Statistically significant but clinically unimportant: a systematic review and meta-analysis of the analgesic benefits of erector spinae plane block following breast cancer surgery. Reg Anesth Pain Med 2021;46(1):3-12. google scholar Barrington MJ. Erector spinae plane block: did low p values overstate the evidence against the null hypothesis and distract us from clinically unimportant effects? Reg Anesth Pain Med 2021;46(1):1-2. google scholar Hung KC, Liao SW, Sun CK. Comparable analgesic efficacy between erector spinae plane and thoracic paravertebral blocks for breast and thoracic surgeries? J Clin Anesth 2021;71:110200. google scholar Chin KJ. Erector spinae plane and paravertebral blocks have similar opioid-sparing effects following breast surgery. Reg Anesth Pain Med 2020;45(11):940. google scholar Turhan O, Sivrikoz N, Sungur Z, Duman S, Ozkan B, Senturk M. Thoracic paravertebral block achieves better pain control than erector spinae plane block and intercostal nerve block in thoracoscopic surgery: a randomized study. J Cardiothorac Vasc Anesth 2021;35(10):2920-7. google scholar Jacobs A, Lemoine A, Joshi GP, Van de Velde M, Bonnet F, collaborators PWG. PROSPECT guideline for oncological breast surgery: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2020;75(5):664-73. google scholar Zhao Y, Tao Y, Zheng S, Cai N, Cheng L, Xie H, et al. Effects of erector spinae plane block and retrolaminar block on analgesia for multiple rib fractures: a randomized, double-blinded clinical trial. Braz J Anesthesiol 2022;72(1):115-21. google scholar Zhang Y, Liu T, Zhou Y, Yu Y, Chen G. Analgesic efficacy and safety of erector spinae plane block in breast cancer surgery: a systematic review and meta-analysis. BMC Anesthesiol 2021;21(1):59. google scholar Huang W, Wang W, Xie W, Chen Z, Liu Y. Erector spinae plane block for postoperative analgesia in breast and thoracic surgery: A systematic review and meta-analysis. J Clin Anesth 2020;66:109900. google scholar Leong RW, Tan ESJ, Wong SN, Tan KH, Liu CW. Efficacy of erector spinae plane block for analgesia in breast surgery: a systematic review and meta-analysis. Anaesthesia 2021;76(3):404-13. google scholar Cowie B, McGlade D, Ivanusic J, Barrington MJ. Ultrasound-guided thoracic paravertebral blockade: a cadaveric study. Anesth Analg 2010;110(6):1735-9. google scholar Nielsen MV, Moriggl B, Hoermann R, Nielsen TD, Bendtsen TF, Borglum J. Are single-injection erector spinae plane block and multiple-injection costotransverse block equivalent to thoracic paravertebral block? Acta Anaesthesiol Scand 2019;63(9):1231-8. google scholar Bonvicini D, Boscolo-Berto R, De Cassai A, Negrello M, Macchi V, Tiberio I, et al. Anatomical basis of erector spinae plane block: a dissection and histotopographic pilot study. J Anesth 2021;35(1):102-11. google scholar Zhao H, Xin L, Feng Y. The effect of preoperative erector spinae plane vs. paravertebral blocks on patient-controlled oxycodone consumption after video-assisted thoracic surgery: A prospective randomized, blinded, non-inferiority study. J Clin Anesth 2020;62:109737. google scholar El Ghamry MR, Amer AF. Role of erector spinae plane block versus paravertebral block in pain control after modified radical mastectomy. A prospective randomised trial. Indian J Anaesth 2019;63(12):1008-14. google scholar Boughey JC, Goravanchi F, Parris RN, Kee SS, Kowalski AM, Frenzel JC, et al. Prospective randomized trial of paravertebral block for patients undergoing breast cancer surgery. Am J Surg 2009;198(5):720-5. google scholar Fahy AS, Jakub JW, Dy BM, Eldin NS, Harmsen S, Sviggum H, et al. Paravertebral blocks in patients undergoing mastectomy with or without immediate reconstruction provides improved pain control and decreased postoperative nausea and vomiting. Ann Surg Oncol 2014;21(10):3284-9. google scholar Moustafa MA, Alabd AS, Ahmed AMM, Deghidy EA. Erector spinae versus paravertebral plane blocks in modified radical mastectomy: Randomised comparative study of the technique success rate among novice anaesthesiologists. Indian J Anaesth 2020;64(1):49-54. google scholar Brodsky JB, Mariano ER. Regional anaesthesia in the obese patient: lost landmarks and evolving ultrasound guidance. Best Pract Res Clin Anaesthesiol 2011;25(1):61-72. google scholar