POSTOPERATIVE PAIN RELIEF IN PATIENTS UNDERGOING UNILATERAL MODIFIED RADICAL MASTECTOMY; COMPARISON BETWEEN ULTRASOUND GUIDED ERECTOR SPINAE PLANE BLOCK VERSUS ULTRA SOUND GUIDED THORACIC PARAVERTEBRAL BLOCK

Abstract

Background: Postoperative pain following breast cancer surgery significantly impacts patient recovery and quality of life. Effective regional anesthesia techniques, such as ultrasound-guided thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB), have been utilized to optimize pain management. TPVB is considered superior due to its ability to provide a more targeted blockade of thoracic spinal nerves, potentially offering prolonged analgesia. However, comparative studies evaluating the effectiveness of these two techniques remain limited, particularly in the context of unilateral modified radical mastectomy.

Objective: To compare the efficacy of ultrasound-guided TPVB and ESPB in postoperative pain relief for patients undergoing unilateral modified radical mastectomy for breast cancer.

Methods: This randomized controlled trial was conducted in the Department of Anesthesia, Khyber Teaching Hospital, Peshawar, following ethical approval. A total of 116 female patients, aged 18–60 years, with ASA physical status I–III, were enrolled and randomized into two equal groups. Group A received ESPB, while Group B underwent TPVB, both performed under ultrasound guidance using 0.25% bupivacaine. Postoperative pain intensity was assessed using the visual analog scale (VAS) at the 12th postoperative hour. Statistical analysis was performed in SPSS version 25.0, with independent sample t-tests or Mann-Whitney U tests used for group comparisons.

Results: Group B (TPVB) exhibited significantly lower postoperative pain levels than Group A (ESPB). The mean VAS score in the TPVB group was 1.10 ± 0.89, compared to 2.14 ± 1.02 in the ESPB group (p = 0.0001). Stratified analysis indicated statistically significant associations between demographic factors and postoperative pain scores (p < 0.05).

Conclusion: TPVB provided superior postoperative pain relief compared to ESPB in patients undergoing unilateral modified radical mastectomy. Given its enhanced analgesic efficacy, TPVB should be considered the preferred regional anesthesia technique for optimizing postoperative pain management in breast cancer surgery.