Regional blockage as a component of reduced mammoplasty multimodal pain relief

Relevance. Postoperative pain management remains poorly understood. Analgesics traditionally used to treat postoperative pain have numerous side effects. The optimal method for preventing postoperative pain is based on the principle of multimodality, where in addition to the use of analgesics with different application points, regional blockades are applied. In chest wall surgery, blockage of the thoracic nerves (PEC block) and the space of the muscles of the spine straightener (ESP block) under ultrasound control are gaining popularity.

Objective. We compared the analgesic efficiency of PEC block and ESP block in multimodal analgesis without opioids during the postoperative period of reduction mammoplasty.

Materials and methods. Sixty patients were examined with bilateral reduction mammography. Three groups were selected: PEC group of the block (n=20), ESP group of the block (n=20), and control group (n=20). The amount of fentanyl and inhalant anesthetic consumed, postoperative pain on Visual Analogue Scale (VAS), side effects of analgesics, and patient activation were evaluated.

Results. Intraoperative fentanyl and inhalant consumption were significantly lower in the block PEC and block ESP groups than in the control group. The post-wake and 1and 3-hour postoperative pain syndrome rates were significantly lower in the block PEC and block ESP groups than in the control group.

Conclusions. ESP-block and PEC-block are effective regional anesthesia methods that provide good intra- and postoperative analgesia. They also have a significant opioid-saving effect. They allow significantly earlier activation of patients. ESPblock slightly surpassed PEC block in duration, but other differences were not.

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