Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: A Randomized, Subject-Masked, Active-Controlled, Parallel-Arm Clinical Trial Comparing Erector Spinae and Paravertebral Nerve Blocks
Brief Summary: Following painful surgical procedures of the breast, postoperative analgesia is often provided with a paravertebral nerve block (PVB). For intense, but shorter-duration acute pain, a single-injection of local anesthetic is used with a duration of approximately 12 hours. The PVB has several limitations: it can decrease blood pressure, and very rare-but serious-complications have occurred, including neuraxial injection, neuraxial hematoma, and pleural puncture. An alternative block has been described: the erector spinae plane block. The theoretical benefits include ease of administration since it is a plane superficial to the PVB and therefore easier to identify and target with ultrasound (therefore increasing success rate); and an increased safety margin: there are few anatomic structures in the immediate area which could be injured with the needle; and, the target plane is much further from the intrathecal/epidural space relative to the PVB. Lastly, the plane may be easier to catheterize for continuous peripheral nerve blocks relative to the relatively-small volume PVB.

There are therefore multiple theoretical reasons to prefer the erector spinae plane block. Unfortunately, it remains unknown if the analgesia provided by this new technique is comparable to that provided with the PVB. The investigators therefore propose to compare these two techniques with a randomized, subject-masked, active-controlled, parallel-arm, human subjects clinical trial.


Options:
A: Arm Label: ESP group; Type: ACTIVE_COMPARATOR; Interventions: Device: Intravenous morphine patient controlled device, Other: Erector Spinae Plane Block | Arm Label: TPVB group; Type: ACTIVE_COMPARATOR; Interventions: Device: Intravenous morphine patient controlled device, Other: Thoracic Paravertebral Block | Arm Label: Control Group; Type: OTHER; Interventions: Device: Intravenous morphine patient controlled device | Intervention Type: DEVICE; Name: Intravenous morphine patient controlled device; Assigned to Arm(s): Control Group, ESP group, TPVB group | Intervention Type: OTHER; Name: Erector Spinae Plane Block; Assigned to Arm(s): ESP group | Intervention Type: OTHER; Name: Thoracic Paravertebral Block; Assigned to Arm(s): TPVB group
B: Arm Label: Erector Spinae (single injection); Type: EXPERIMENTAL; Interventions: Drug: Erector Spinae (single injection) | Arm Label: Paravertebral (single injection); Type: ACTIVE_COMPARATOR; Interventions: Drug: Paravertebral (single injection) | Intervention Type: DRUG; Name: Erector Spinae (single injection); Assigned to Arm(s): Erector Spinae (single injection) | Intervention Type: DRUG; Name: Paravertebral (single injection); Assigned to Arm(s): Paravertebral (single injection)
C: Arm Label: Erector Spinae Plane Block; Type: ACTIVE_COMPARATOR; Interventions: Procedure: Erector Spinae Plane block, Drug: Bupivacaine Hydrochloride, Device: PCA | Arm Label: Control Group; Type: SHAM_COMPARATOR; Interventions: Procedure: Sham block, Device: PCA | Intervention Type: PROCEDURE; Name: Erector Spinae Plane block; Assigned to Arm(s): Erector Spinae Plane Block | Intervention Type: PROCEDURE; Name: Sham block; Assigned to Arm(s): Control Group | Intervention Type: DRUG; Name: Bupivacaine Hydrochloride; Assigned to Arm(s): Erector Spinae Plane Block | Intervention Type: DEVICE; Name: PCA; Assigned to Arm(s): Control Group, Erector Spinae Plane Block
D: Arm Label: Erector Spinae Plane Block; Type: ACTIVE_COMPARATOR; Interventions: Procedure: Erector Spinae Plane Block | Arm Label: Deep and Superficial Serratus Anterior Plane Block; Type: ACTIVE_COMPARATOR; Interventions: Procedure: Deep and Superficial Serratus Anterior Plane Block | Intervention Type: PROCEDURE; Name: Erector Spinae Plane Block; Assigned to Arm(s): Erector Spinae Plane Block | Intervention Type: PROCEDURE; Name: Deep and Superficial Serratus Anterior Plane Block; Assigned to Arm(s): Deep and Superficial Serratus Anterior Plane Block

Answer: B