Efect of Erector Spina Plane Block on Mastectomy
Condition: Pain, Postoperative; Opioid Use
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      After breast cancer surgery, more than 60% of patients experience persistent pain.Although
      opioids are the main method of use in postoperative pain management, there are side effects
      such as constipation, sedation, respiratory depression, urinary retention, itching,
      postoperative nausea and vomiting.Erector spina plane block (ESPB) is a technique used in
      many surgeries for anesthesia and analgesia.It is frequently preferred by anesthesiologists
      for postoperative analgesia recently because it is easy to apply and no complications are
      reported in the literature.ESPB with arms of iliocostalis, longissimus and spinalis, is
      located parallel to the spine, from the back of the skull to the pelvis.The injected local
      anesthetic is distributed in many levels in the cranio-caudal direction and blocks the
      intercostal spinal nerves, causing sensory block.Providing the necessary perioperative
      analgesia due to the complex innervation of the breast tissue is a big controversy among
      anesthesiologists.Multimodal analgesia methods with various regional blocks are more
      preferred.ESPB block is also preferred as another method since it provides both perioperative
      and postoperative analgesia.In studies conducted on cadavers, it has been shown that local
      analgesia spreads to the paravertebral area when applied under the Erektor Spina
      muscle.Technically, compared to the paravertebral block,the ESPB has proven to be more
      reliable and easier in terms of pleural puncture risk.

      ANI is a monitoring method used in the evaluation of acute nociception and pain.Analyzes the
      instantaneous changes in heart rate due to the activation of the parasympathetic nervous
      system using respiratory sinus arrhythmia.A value between 0-100 is obtained.If
      parasympathetic modulation is very low, a value of 0 is obtained, if it is high, a value of
      100 is obtained.ANI detects the noxious stimulus more specifically and sensitively than heart
      rate and blood pressure changes.

      Application of anesthesia and having ANI value between 50-70 in the early postoperative
      period indicates that analgesia is sufficient,and values <50 are the following 10
      minutes.Hemodynamic reactivity (20% increase in heart rate or blood pressure) will occur and
      the level of analgesia is insufficient,and values> 70 indicate that there is no painful
      stimulus or that more analgesic drugs are used.
    

Detailed description: 
      After breast cancer surgery, more than 60% of patients experience persistent pain (1).
      Although opioids are the main method of use in postoperative pain management, there are side
      effects such as constipation, sedation, respiratory depression, urinary retention, itching,
      postoperative nausea and vomiting (2). Erector spina plane block (ESP) is a technique used in
      many surgeries for anesthesia and analgesia. It is frequently preferred by anesthesiologists
      for postoperative analgesia recently because it is easy to apply and no complications are
      reported in the literature. Erector spina muscle, with arms of iliocostalis, longissimus and
      spinalis, is located parallel to the spine, from the back of the skull to the pelvis. The
      injected local anesthetic is distributed in many levels in the cranio-caudal direction and
      blocks the intercostal spinal nerves, causing sensory block (3). Providing the necessary
      perioperative analgesia due to the complex innervation of the breast tissue is a big
      controversy among anesthesiologists. Multimodal analgesia methods with various regional
      blocks are more preferred. Erector Spina Plane block is also preferred as another method
      since it provides both perioperative and postoperative analgesia (4). In studies conducted on
      cadavers, it has been shown that local analgesia spreads to the paravertebral area when
      applied under the Erektor Spina muscle. Technically, compared to the paravertebral block, the
      Erektor Spina block has proven to be more reliable and easier in terms of pleural puncture
      risk (5).

      ANI is a monitoring method used in the evaluation of acute nociception and pain (Figure 2.1).
      Analyzes the instantaneous changes in heart rate due to the activation of the parasympathetic
      nervous system using respiratory sinus arrhythmia. A value between 0-100 is obtained. If
      parasympathetic modulation (stress level eg presence of pain) is very low, a value of 0 is
      obtained, if it is high, a value of 100 is obtained (7). ANI detects the noxious stimulus
      more specifically and sensitively than heart rate and blood pressure changes (6).

      The "yellow colored value" on the upper right corner of the ANI monitor shows the
      instantaneous ANI value, while the orange colored one shows the average ANI value in the last
      4 minutes. (Figure 2.1). Application of anesthesia and having ANI value between 50-70 in the
      early postoperative period indicates that analgesia is sufficient, and values <50 are the
      following 10 minutes. A hemodynamic reactivity (20% increase in heart rate or blood pressure)
      will occur and the level of analgesia is insufficient, and values> 70 indicate that there is
      no painful stimulus or that more analgesic drugs are used (6). After breast cancer surgery,
      more than 60% of patients experience persistent pain (1). Although opioids are the main
      method of use in postoperative pain management, there are side effects such as constipation,
      sedation, respiratory depression, urinary retention, itching, postoperative nausea and
      vomiting (2). Erector spina plane block (ESP) is a technique used in many surgeries for
      anesthesia and analgesia. It is frequently preferred by anesthesiologists for postoperative
      analgesia recently because it is easy to apply and no complications are reported in the
      literature. Erector spina muscle, with arms of iliocostalis, longissimus and spinalis, is
      located parallel to the spine, from the back of the skull to the pelvis. The injected local
      anesthetic is distributed in many levels in the cranio-caudal direction and blocks the
      intercostal spinal nerves, causing sensory block (3). Providing the necessary perioperative
      analgesia due to the complex innervation of the breast tissue is a big controversy among
      anesthesiologists. Multimodal analgesia methods with various regional blocks are more
      preferred. Erector Spina Plane block is also preferred as another method since it provides
      both perioperative and postoperative analgesia (4). In studies conducted on cadavers, it has
      been shown that local analgesia spreads to the paravertebral area when applied under the
      Erektor Spina muscle. Technically, compared to the paravertebral block, the Erektor Spina
      block has proven to be more reliable and easier in terms of pleural puncture risk (5).

      ANI is a monitoring method used in the evaluation of acute nociception and pain (Figure 2.1).
      Analyzes the instantaneous changes in heart rate due to the activation of the parasympathetic
      nervous system using respiratory sinus arrhythmia. A value between 0-100 is obtained. If
      parasympathetic modulation (stress level eg presence of pain) is very low, a value of 0 is
      obtained, if it is high, a value of 100 is obtained (7). ANI detects the noxious stimulus
      more specifically and sensitively than heart rate and blood pressure changes (6).

      The "yellow colored value" on the upper right corner of the ANI monitor shows the
      instantaneous ANI value, while the orange colored one shows the average ANI value in the last
      4 minutes. (Figure 2.1). Application of anesthesia and having ANI value between 50-70 in the
      early postoperative period indicates that analgesia is sufficient, and values <50 are the
      following 10 minutes. A hemodynamic reactivity (20% increase in heart rate or blood pressure)
      will occur and the level of analgesia is insufficient, and values> 70 indicate that there is
      no painful stimulus or that more analgesic drugs are used (6).
    

Intervention name(s): erector spinae block
Intervention type(s): Procedure
Intervention description(s): Erector spina plane block (ESP) is a technique used in many surgeries for anesthesia and analgesia. It is frequently preferred by anesthesiologists for postoperative analgesia recently because it is easy to apply and no complications are reported in the literature. Erector spina muscle, with arms of iliocostalis, longissimus and spinalis, is located parallel to the spine, from the back of the skull to the pelvis. The injected local anesthetic is distributed in many levels in the cranio-caudal direction and blocks the intercostal spinal nerves, causing sensory block. Providing the necessary perioperative analgesia due to the complex innervation of the breast tissue is a big controversy among anesthesiologists. Multimodal analgesia methods with various regional blocks are more preferred. Erector Spina Plane block is also preferred as another method since it provides both perioperative and postoperative analgesia
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Other
Keywords: erector spinae plane block; opioid consumption; mastectomy; Analgesia nosiseption index