Background and aims Women undergoing breast cancer surgery often experience severe post-operative pain and may develop chronic postoperative pain. The aim of the study was to evaluate the analgesic efficacy of erector spine plane (ESP) block for postoperative analgesia in breast cancer surgery. The primary outcome of this study was 24-hour morphine consumption and secondary outcomes were time to first rescue analgesia, pain scores and adverse effects.

Methods After institutional ethics committee approval (reference no. NK/3870/MD/339 dated September 21, 2016)(CTRI/2018/03/012307), 60 ASA I or II patients aged 18–60 years, scheduled for elective breast cancer surgery under general anaesthesia were randomly allocated in to either ESP group or control group. Ultrasound (US)-guided ESP block with 0.4 ml/kg of 0.5% ropivacaine at the T5 vertebral level was performed preoperatively in ESP group. Patient-controlled morphine analgesia was used for postoperative pain relief in both the groups. Postoperatively patients were assessed for pain using NRS score at fixed time intervals for 24 hours, time for first rescue analgesia and total analgesic consumption in first 24 hrs were noted.

Results 24-hour morphine consumption in the ESP group decreased by 42% compared to the control group (2.9± 2.5 mg vs 5.0 ± 2.1 mg) (P- 0.01). The NRS score was significantly lower in ESP group at all intervals up to 6 hours of surgery (p<0.05).

Conclusions Ultrasound guided ESP block exhibits a significant analgesic effect in patients undergoing breast cancer surgery. Further studies comparing different regional anaesthesia techniques are needed to identify the optimal analgesia technique for this group of patients.