Analgesic Efficacy of Erector Spinae Plane Block After Breast Cancer Surgery

Study Overview
=================
Brief Summary
-----------------
Erector spinae plane block(ESPB), which is firstly used for thoracic neuropathic pain, is newly developed and highly promising fascial plane block for providing postoperative analgesia for a great deal of surgeries including breast surgery. The investigators aim to study efficacy of ESPB for patients who undergone breast cancer surgery and is expected to benefit from opioid-sparing effect of this technique.

Detailed Description
-----------------
This is a retrospective, single-center clinical trial to evaluate analgesic efficacy of Erector spinae plane block (ESPB) after breast cancer surgery. Participant's demographics and medical history, type and extent of surgery, systemic opioid and non-opioid analgesic consumptions, hemodynamic variables and adverse events during and first 24 hours after surgery. After operation, pain scores at first 24 hours, 1., 3., and 6. month will be obtanied from surgical ward and pain clinic registires. patient controlled analgesia device usage history will be obtained from device database at our clinic.

Official Title
-----------------
Analgesic Efficacy of Erector Spinae Plane Block After Breast Cancer Surgery

Conditions
-----------------
Postoperative Pain, Breast Cancer

Intervention / Treatment
-----------------
* Procedure: Ultrasound guided Erector Spinae Plane Block (ESPB)


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: ASA I-II patients undergoing breast surgery for breast cancer Becoming available of complete records about study data Exclusion Criteria: ASA III-IV patients missing records about study data

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
-----------------
Female

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Erector Spinae<br>patients who are administered ultrasound guided ESPB at T4 vertebrae level with long acting local anesthetic (%0,25 bupivacaine) and followed up with patient controlled analgesia device and all records about aforementioned data is completely available. | Procedure: Ultrasound guided Erector Spinae Plane Block (ESPB)<br>* Ultrasound guided ESPB is applied at T4 vertebrae level, 3 cm lateral to mid-line where transverse process lies. After identification of transverse process, needle is advanced in plane and real time visualisation on ultrasound screen. When bonny contact is encountered, normal saline is injected for verification of placement, then, 25 ml %0,25 bupivacaine is injected plane between transverse process and erector spinae muscles.<br>|
| Control<br>patients who are not administered any regional analgesic technique and followed up with patient controlled analgesia device and all records about aforementioned data is completely available. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Opioid Consumption | all patients were given 0.05 mg/kg morphine iv and 1 gr paracetamol 30 minutes before end of surgery and in the recovery room, a patient- controlled analgesia device containing morphine 0.5 mg/ml, set to deliver a 1mg bolus dose of morphine with an 10 min lockout time. Total morphine consumption during the 24 hours postoperative period will recorded at 5 times intervals ( 2, 4, 6, 12, 24 hours). | First 24 hours after surgery | 
| Verbal Analog Pain Scores on rest and movement | A Research assistant, blinded to the group allocation, interviewed patients and collected data at 5 times intervals ( 2, 4, 6, 12, 24, hours) in the 24 hours postoperatively. Patients were asked to rate their pain using verbal analog scale, where 0= no pain and 10= worst pain possible. | First 24 hours after surgery, at 1., 3., 6. month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Demographic Data | Age, sex, medical history, BMI, ASA (American Society of Anesthesiologists) status, Duration and type of surgery were recorded | First 24 hours after surgery | 
| Blood Pressures | systolic, diastolic and mean arterial blood pressures as mmHg | during and first 24 hours after surgery | 
| Heart Rate | Heart rate as beat per minute (BPM) | during and first 24 hours after surgery | 
| incidence of adverse effects (like nausea and vomiting) | incidence of nausea and vomiting during the 24 hours postoperative period was recorded recorded at 5 times intervals ( 2, 4, 6, 12, 24 hours) | First 24 hours after surgery | 
| Rescue analgesic requirement | number of request and dosages of non opioid analgesics used for VAS equal or greater than 5 or patient request. | First 24 hours after surgery | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Erector spinae plane block, breast cancer, surgery, postoperative pain, analgesic