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Abstract
Background and Aims Opioid use has been associated with unwanted side effects and cancer recurrence. Regional anesthesia may provide better analgesia, reduce opioid usage, and may reduce cancer progression. We conducted this trial to study the efficacy of erector spinae block ( ESP) based anesthesia on postoperative opioid consumption and immune cell expression in patients undergoing breast cancer surgery.
Methods After ethics committee approval, 100 female patients undergoing breast cancer surgery were randomly allocated into two groups: group N (received ESP intraoperative opioids) and group O (received intraoperative opioid). Standard anaesthesia technique followed and post extubation morphine given using patient -controlled-analgesia pump. 24-hours postoperative morphine consumption was calculated (Primary outcome). The secondary outcomes were NRS (numerical rating scale) for pain and any side effect of opioid at 0, 30 min, 1 hour, 2-hour, 6-hour, 24-hour post operatively and Neutrophil-lymphocyte ratio (NLR), number of Natural Killer Cells (NKCs), T-helper cells and cytotoxic T cells at baseline, immediate post-operative period and after 24 hours.
Results Total post-operative morphine consumption (2.0±2.12mg vs. 3.08±3.69mg; p-value=0.132) and change in NLR from baseline at 24 hours was less with ESP. NRS scores at rest and movement at various time points were similar. NKC, T-helper cells and cytotoxic T cells were found to be higher in the ESP group.
Conclusions ESP block provided similar postoperative morphine consumption and lesser immunosuppression in breast cancer surgeries as compared to standard opioid based technique. Further studies are needed to see the feasibility of ESP based opioid technique and develop standard protocol with minimal side effects.