Article Text

Download PDFPDF
ESRA19-0639 The ultrasound-guided erector spinae plane block allows opioid free anesthesia in the modified radical mastectomy with axillary dissection: a pilot study about 14 cases
  1. S El Ayoubi1,
  2. A Ghannam2,
  3. B El Ahmadi2 and
  4. Z Belkhadir2
  1. 1Ibn Sina Teaching Hospital, Anethesiology, Rabat, Morocco
  2. 2National Oncology Institute, Anesthesiology, Rabat, Morocco


Background and aims The modified radical mastectomy with axillary dissection is usually carried out under balanced general anesthesia using opiates, it is a source of moderate to severe postoperative acute pain. Opioid-free anesthesia (OFA) aims to reduce the undesirable effects of opioids while ensuring optimal anesthesia and analgesia perioperatively. We report 14 cases of ultrasound-guided erector spinae plane block (ESPB) to perform surgery using OFA.

Methods We recruited patients presenting no contraindications to the anesthetic technique. the OFA protocol included a general anesthesia with no opioids and an ultrasound-guided ESPB with bupivacaine at T4 level. Prior to incision, patients received a bolus of Ketamine, Ketoprofen, dexamethasone IV. Maintenance of anesthesia was performed by sevoflurane at 1 MAC. In case of haemodynamic repercussions related to nociception, a bolus of fentanyl at 1 μg/kg was administered.

Results After the approval of the ethic committee, we included 14 consenting patients. Hemodynamic variations were all less than 20% of baseline. No patient had any intraoperative opiate injection. Upon waking, patients had a median visual analogical scale (VAS) less than 3. During the first 24 hours, the VAS was less than 3. Only one patient received a bolus of 3 mg morphine IV as part of the catch-up postoperative analgesia. After 24 h, all patients had no resting pain.

Conclusions OFA is used to avoid short-term and long-term adverse effects of opioids, such as: nausea, postoperative hyperalgesia, chronic pain and tumor recurrence. the ESPB allows anesthesia and analgesia in a safe way.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.