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The efficacy of ultrasound-guided erector spinae plane block after mastectomy and immediate breast reconstruction with a tissue expander: a randomized clinical trial

Korean Journal of Pain 2021년 34권 1호 p.106 ~ 113
박석희, 박주현, 최지원, 방유정, 오은정, 박지연, 홍관영, 심우석,
소속 상세정보
박석희 ( Park Suk-Hee ) - Catholic Kwandong University College of Medicine International St. Mary’s Hospital Department of Anesthesiology and Pain Medicine
박주현 ( Park Joo-Hyun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Anesthesiology and Pain Medicine
최지원 ( Choi Ji-Won ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Anesthesiology and Pain Medicine
방유정 ( Bang Yu-Jeong ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Anesthesiology and Pain Medicine
오은정 ( Oh Eun-Jung ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Anesthesiology and Pain Medicine
박지연 ( Park Ji-Yeon ) - Catholic Kwandong University College of Medicine International St. Mary’s Hospital Department of Anesthesiology and Pain Medicine
홍관영 ( Hong Kwan-Young ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Anesthesiology and Pain Medicine
심우석 ( Sim Woo-Seog ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Anesthesiology and Pain Medicine

Abstract


Background: We aimed to investigate the analgesic efficacy of an erector spinae plane block (ESPB) in immediate breast reconstruction (IBR) with a tissue expander.

Methods: Adult women undergoing IBR with a tissue expander after mastectomy were randomly assigned to either intravenous patient-controlled analgesia (IV-PCA) alone (group P) or IV-PCA plus ESPB (group E). The primary outcome was the total amount of opioid consumption during 24 hours postoperatively between the two groups. Secondary outcomes were patient satisfaction, pain score at rest and on shoulder movement using numerical rating scale, incidences of postoperative nausea and vomiting (PONV), and a short form of the brief pain inventory (BPI-SF) at 3 and 6 months after surgery between the groups.

Results: Fifty eight patients completed the study. At 24 hours postoperatively, total opioid consumption was significantly less in group E than in group P (285.0 ± 92.0, 95% confidence interval [CI]: 250.1 to 320.0 vs. 223.2 ± 83.4, 95% CI: 191.5 to 254.9, P = 0.005). Intraoperative and cumulative PCA fentanyl consumption at 3, 6, 9, and 24 hours were also less in group E than in group P (P = 0.004, P = 0.048, P = 0.020, P = 0.036, and P < 0.001, respectively). Patient satisfaction was higher in group E (6.9 ± 1.8 vs. 7.8 ± 1.4, P = 0.042). The incidences of PONV was similar.

Conclusions: The ESPB decreased postoperative opioid consumption and increased patient satisfaction without significant complications after IBR with a tissue expander after mastectomy.

키워드

Analgesia; Breast Implants; Breast Neoplasms; Mastectomy; Nerve Block; Pain, Postoperative; Patient Satisfaction; Reconstructive Surgical Procedures; Tissue Expansion Devices; Ultrasonography, Interventional

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