ESPB and RIB for Pain Management Following Mastectomy Surgery
Condition: Breast Cancer; Breast Neoplasms; Breast Cancer Female
MeSH terms: Breast Neoplasms
Study type: Interventional

Summary: 
      Postoperative pain is an important issue in patients underwent mastectomy and axillary
      dissection surgery. Postoperative effective pain treatment provides early mobilization and
      shorter hospital stay. The US-guided erector spina plane block (ESPB) may be used for
      postoperative pain treatment following breast surgery. It is a novel interfascial block that
      was defined by Forero. Rhomboid intercostal block (RIB) is a novel block and was first
      described by Elsharkawy et al. Local anesthetic solution is administrated between the
      rhomboid muscle and intercostal muscles over the T5-6 ribs. It has been reported that RIB may
      provide effective analgesia management for several breast surgeries.

      The primary aim of the study is to compare postoperative pain scores (VAS), and the secondary
      aim is to evaluate postoperative opioid consumption, adverse effects related with opioids
      (allergic reaction, nausea, vomiting).
    

Detailed description: 
      Postoperative pain is an important issue in patients underwent mastectomy and axillary
      dissection surgery. Postoperative effective pain treatment provides early mobilization and
      shorter hospital stay, thus complications due to hospitalization such as infection and
      thromboembolism may be reduced.

      Various methods may be performed to reduce the use of systemic opioids and for effective pain
      treatment following mastectomy and axillary dissection surgery. Ultrasound (US)-guided
      interfascial plane blocks have been used increasingly due to the advantages of ultrasound in
      anesthesia practice. Rhomboid intercostal block (RIB) is a novel block and was first
      described by Elsharkawy et al. Local anesthetic solution is administrated between the
      rhomboid muscle and intercostal muscles over the T5-6 ribs 2-3 cm medially of the medial
      border of the scapula. RIB targets both the posterior rami and lateral cutaneous branches of
      the thoracic nerves and provides analgesia for the hemithorax from T2 to T9. It has been
      reported that RIB may provide effective analgesia management for several breast surgeries.

      The US-guided erector spina plane block (ESPB) is defined by Forero et al. ESPB provides
      thoracic analgesia at T5 level and abdominal analgesia at T7-9 level. ESPB contains a local
      anesthetic injection into the deep fascia of erector spinae. Visualization of sonoanatomy is
      easy, and the spread of local anesthesic agents can be easily seen under the erector spinae
      muscle. Thus, analgesia occurs in several dermatomes with cephalad-caudad way. In the
      literature, it has been reported that ESP block provides effective analgesia after several
      surgeries such as open heart surgery, breast surgery, thoracoscopic and abdominal operations.

      The aim of this study is to evaluate the efficacy of the US-guided ESPB and RIB for
      postoperative analgesia after mastectomy and axillary dissection surgery. The primary aim is
      to compare postoperative pain scores (VAS), and the secondary aim is to evaluate opioid
      consumption, adverse effects related with opioids (allergic reaction, nausea, vomiting).
    

Intervention name(s): Analgesia management; group ESPB and RIB
Intervention type(s): Other
Intervention description(s): Patients will be administered ibuprofen 400 mgr IV every 8 hours in the postoperative period. A patient controlled device prepared with 10 mcg/ ml fentanyl will be attached to all patients with a protocol included 10 mcg bolus without infusion dose, 10 min lockout time and 4 hour limit. Postoperative patient evaluation will be performed by an anesthesiologist blinded to the procedure.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: There are two models for this study. The first group is ESPB group. The second one is RIB group
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Mastectomy and axillary dissection surgery; Postoperative pain management; Rhomboid intercostal block; Erector spina plane block