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#36481 Combined us-guided erector spinae plane block (ESP) + parasternal block (PSB): new perspectives in opioid-free anesthesia for oncological major breast surgery
  1. Longo Ferdinando1,
  2. Francesca De Caris2,
  3. Alessandro Strumia2,
  4. Monica Palminteri2,
  5. Renato Ricciardi2 and
  6. Felice Eugenio Agrò3
  1. 1Rome, Italy
  2. 2Department Of Anesthesia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro Del Portillo 200, 00128, Rome, Roma, Italy
  3. 3Chief Department Of Anesthesia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro Del Portillo 200, 00128, Rome, Roma, Italy


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Background and Aims In breast surgery, locoregional anesthesia has shown its effectiveness in pain management and in preventing the onset of post-mastectomy pain syndrome (PMPS). In particular, a totally opioid-free approach can be reserved for fragile patients. We experienced a series of ESP block and parasternal (PSB) block combination as a new approach for analgesia in modified radical mastectomy (MRM).

Methods We selected five patients from 34 to 68 years old who underwent a modified radical mastectomy; ESP block was performed at T5 level with 25 ml of ropivacaine 0,5% and PSB block was administered with 10 ml of ropivacaine 0,5% between II and IV ribs for a better cover of the anteromedial wall chest. Patients underwent general anesthesia with a supraglottic device and opiods were given neither during or after surgery. Intravenous Paracetamol was provided every 8 hrs for 24 hrs.

Results Pain score in a NRS scale, mgs of morphine demanded by patients and presence of PONV were recorded. Four of five patients reported a pain score

<3 on the NRS scale, only 1 patient required 1 mg of morphine at 6 hrs with a score of 5 on NRS scale. No other symptoms were described. Furthermore, at a three-month post-operative follow-up, no pain >2 on the NRS scale was reported.

Abstract #36481 Figure 1

US-guided ESP block usually performed in prone position at T5 level right before general anesthesia

Abstract #36481 Figure 2

US-guided PSB performed between the pectoral major muscle and the internal intercostal muscle right after putting the patient under general anesthesia

Conclusions Combination of ESP block + PSB block has shown efficacy in ensuring good pain management during and after MRM in a totally opioid-free anesthesia perspective. Moreover, the low onset of pain at three months suggests its potential in PMPS prevention.

  • breast surgery
  • thoracic fascial plane blocks
  • case report
  • case series
  • opiod-free anesthesia

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