Background and Aims Severe pain occurs after reduction mammaplasty surgery which may be prevented via preoperative erector spinae plane block (ESPB) or thoracic paravertebral block (TPVB)[1,2]. We aimed to compare perioperative analgesic features of these two blocks.

Methods After Istanbul Faculty of Medicine Clinical Research Ethics Committee approval (2020/1423) fifty-eight macromastia patients were investigated retrospectively. Prior to surgery; patients were applied ESPB (n=28) on T4 level or TPVB (n=30) between T3-T4 levels. Pin-prick test covering T2 to T6 dermatomes was performed on midaxillary and midclavicular lines at certain time points during preoperative 30 minutes and postoperative 48 hours. Demographic data, postoperative comfort parameters (NRS pain scores, time to first pain, total analgesic consumption, sleep duration, nausea-vomiting incidence), and patient/surgeon satisfaction scores were evaluated.

Results Demographic data were similar (p>0.05) (Table 1). TPVB covered more dermatomes on midclavicular line at 30th minute (4[3–4] vs 3.5[2–4] on the right; 4[3–4] vs 3[2–4] on the left; p<0.05). TPVB represented more coverage during the postoperative 24 hours (p<0.05) but not at 48th hour (p>0.05) (Table 2). Pain scores were lower during the postoperative first 2 hours in TPVB group (p<0.05). Time to first pain (NRS≥4) was shorter in ESPB group (411 min vs 605 min; p<0.05). ESPB group consumed more paracetamol on postoperative 2nd day (0[0–2] g vs 1[0–2] g, p<0.05). TPVB group had more sleep on postoperative 1st day (p<0.05); and patients were more satisfied (p<0.05) (Table 3).

Conclusions Thoracic paravertebral block provides more analgesic efficacy and postoperative comfort than erector spinae plane block for reduction mammaplasty patients.