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Original Article

Korean J Pain 2019; 32(3): 206-214

Published online July 1, 2019 https://doi.org/10.3344/kjp.2019.32.3.206

Copyright © The Korean Pain Society.

Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study

Boohwi Hong1 , Seunguk Bang2,3 , Woosuk Chung1 , Subin Yoo2,3 , Jihyun Chung2,3 , Seoyeong Kim2,3

1Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
2Department of Anesthesiology and Pain Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
3Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to:Seunguk Bang
Department of Anesthesiology and Pain Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon 34943, Korea
Tel: +82-42-220-9046, Fax: +82-42-252-6807, E-mail: seungukb@naver.com
ORCID: https://orcid.org/0000-0001-6609-7691

Received: January 14, 2019; Revised: April 9, 2019; Accepted: April 15, 2019

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Although case reports have suggested that the erector spinae plane block (ESPB) may help analgesia for patients after breast surgery, no study to date has assessed its effectiveness. This retrospective observational study analyzed the analgesic effects of the ESPB after total mastectomy.

Methods

Forty-eight patients were divided into an ESPB group (n = 20) and a control group (n = 28). Twenty patients in the control group were selected by their propensity score matching the twenty patients in the ESPB group. Patients in the ESPB group were injected with 30 mL 0.375% ropivacaine, followed by catheter insertion for further injections of local anesthetics every 12 hours. Primarily, total fentanyl consumption was compared between the two groups during the first 24 hours postoperatively. Secondary outcomes included pain intensity levels (visual analogue scale) and incidence of postoperative nausea and vomiting (PONV).

Results

Median cumulative fentanyl consumption during the first 24 hours was significantly lower in the ESPB (33.0 μg; interquartile range [IQR], 27.0?69.5 μg) than in the control group (92.8 μg; IQR, 40.0?155.0 μg) (P = 0.004). Pain level in the early postoperative stage (<3 hr) and incidence of PONV (0% vs. 55%) were also significantly lower in the ESPB group compared to the control (P = 0.001).

Conclusions

Intermittent ESPB after total mastectomy reduces fentanyl consumption and early postoperative pain. ESPB is a good option for multimodal analgesia after breast surgery.

Keywords: Acute Pain, Analgesia, Anesthesia, Conduction, Breast, Mastectomy, Nerve Block, Pain, Postoperative, Ropivacaine, Ultrasonography