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