ESPBs vs TAPs for Pain Relief After Breast Reconstruction Surgery

Overseen By Manuel Clark

Age: 18+

Sex: Female

Trial Phase: Academic

Sponsor: University of Kansas Medical Center

Must not be taking: Opioids

Disqualifiers: Chronic opioid use, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: Immediate post-operative period

102 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two methods to manage pain after breast reconstruction surgery for women with breast cancer. It compares Erector Spinae Plane blocks (ESPBs) and Transversus Abdominis Plane blocks (TAPs), both using local anesthetics for pain control. The researchers aim to determine if the newer ESPBs provide the same pain relief as the more commonly used TAPs. Women undergoing a specific type of breast reconstruction (DIEP flap surgery) and not using long-term opioids might be suitable for this study. As an unphased trial, it offers an opportunity to explore innovative pain management techniques that could enhance recovery experiences for future patients.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, if you are using opioids regularly, you may not be eligible to participate.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Previous studies have shown promising safety results for both Erector Spinae Plane blocks (ESPBs) and Transversus Abdominis Plane blocks (TAPs). Research indicates that ESPBs are safe and reduce pain and opioid use after surgery, with minimal side effects. Patients receiving ESPBs experienced fewer complications than those without any blocks.

Similarly, TAPs significantly reduce hospital stays and complication rates, including issues like blood swelling (haematomas). TAP blocks effectively and safely manage pain after surgery, especially in abdominal procedures.

Both ESPBs and TAPs are well-tolerated, making them reliable options for post-surgical pain relief. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these treatments because they offer potentially improved pain management strategies after breast reconstruction surgery. Unlike traditional pain relief methods, like opioids and general anesthesia, the Erector Spinae Plane (ESP) block and the Transversus Abdominis Plane (TAP) block are regional anesthesia techniques targeting specific nerve pathways. The ESP block involves injecting anesthetic near the spine to block pain signals from reaching the brain, while the TAP block focuses on numbing the nerves of the abdominal wall. These methods aim to reduce the need for opioids, minimizing side effects and promoting faster recovery.

What evidence suggests that this trial's treatments could be effective for pain relief after breast reconstruction surgery?

This trial will compare the effectiveness of Erector Spinae Plane blocks (ESPBs) and Transversus Abdominis Plane blocks (TAPs) for pain relief after breast reconstruction surgery. Studies have shown that ESPBs effectively reduce pain and decrease the need for opioids after surgery, consistently lowering pain levels and reducing the need for extra pain medication in various surgeries, including breast surgeries. Similarly, TAPs have proven effective, significantly lowering pain and reducing the need for opioids after surgery. Both techniques use local anesthetics to block pain and have successfully managed post-surgery discomfort. ^{1 3 6 7 8}

Are You a Good Fit for This Trial?

This trial is for adult women with breast cancer, who are in good to moderate health (ASA 1-3), and are scheduled for DIEP flap surgery. It's not open to those who regularly use opioids, have allergies to local anesthetics, or can't describe their pain level using a number scale.

Inclusion Criteria

I am a woman with breast cancer, in good to moderate health, getting DIEP flap surgery.

Exclusion Criteria

You are unable to tell how much pain you are feeling using a number scale.

I cannot use certain pain medications due to chronic opioid use or allergies.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either Erector Spinae Plane blocks or Transversus Abdominis Plane blocks for post-operative analgesia following DIEP flap surgery

Immediate post-operative period

1 visit (in-person)

Follow-up

Participants are monitored for pain control and opioid requirements post-surgery

6 months

Multiple visits (in-person and virtual)

What Are the Treatments Tested in This Trial?

Interventions

• Pre-operative Erector Spinae Plane block
• Pre-operative Transversus Abdominus Plane blocks

Trial Overview The study compares two types of pre-operative pain blocks: Erector Spinae Plane blocks (ESPBs) and Transversus Abdominus Plane blocks (TAPs). The goal is to see if ESPBs provide similar pain relief after breast reconstruction surgery as the commonly used TAPs do.

How Is the Trial Designed?

Group I: Group 2: Transversus Abdominis Plane blocks Experimental Treatment 1 Intervention

Transversus Abdominis Plane blocks

Group II: Group 1: Erector Spinae Plane blocks Experimental Treatment 1 Intervention

Erector Spinae Plane blocks

Who Is Running the Clinical Trial?

University of Kansas Medical Center

Lead Sponsor

Trials

527

Recruited

181,000+

Published Research Related to This Trial

Erector spinae plane block (ESPB) significantly reduced opioid consumption and improved pain scores in the first 24 hours after abdominal surgery compared to transversus abdominis plane (TAP) block, although the differences were not clinically significant.

ESPB also extended the duration of pain relief and reduced the incidence of postoperative nausea and vomiting, making it a viable alternative for abdominal wall analgesia, despite not enhancing overall patient satisfaction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Erector Spinae Plane Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Abdominal Surgery: A Systematic Review and Meta-Analysis. Liheng, L., Siyuan, C., Zhen, C., et al.[2022]

The ultrasound-guided erector spinae plane (ESP) block provided significantly better postoperative pain control compared to the transversus abdominis plane (TAP) block, with lower pain scores at multiple time points after total abdominal hysterectomy.

Patients receiving the ESP block experienced a longer duration of analgesia (4.73 hours) and required less rescue analgesia (tramadol) compared to those receiving the TAP block, indicating its superior efficacy in managing postoperative pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized Comparative Study Between Bilateral Erector Spinae Plane Block and Transversus Abdominis Plane Block Under Ultrasound Guidance for Postoperative Analgesia After Total Abdominal Hysterectomy. Shukla, U., Yadav, U., Singh, AK., et al.[2022]

In a study of 83 patients undergoing modified radical mastectomy, thoracic paravertebral block (TPVB) resulted in lower morphine consumption (19.2 mg) compared to erector spinae plane block (ESPB) (21 mg), indicating better analgesic efficiency.

TPVB also provided more comprehensive dermatomal coverage and significantly lower pain scores at all measured time points, suggesting it may be the preferred method for pain management in this surgical context, with similar safety profiles for both techniques.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Paravertebral block versus erector spinae plane block for analgesia in modified radical mastectomy: a randomized, prospective, double-blind study. Sivrikoz, N., Turhan, Ö., Ali, A., et al.[2023]

The erector spinae plane block (ESPB) significantly reduces total morphine consumption and improves pain control compared to general anesthesia in women undergoing modified radical mastectomy, with patients using only 4.9 mg of morphine on average versus 16.4 mg in the control group.

ESPB provides effective postoperative analgesia similar to the paravertebral block (PVB), with both techniques resulting in lower pain scores and longer times to first required anesthesia compared to general anesthesia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison between erector spinae plane block and paravertebral block regarding postoperative analgesic consumption following breast surgery: a randomized controlled study. Elewa, AM., Faisal, M., Sjöberg, F., et al.[2022]

In a study of 60 patients undergoing elective cesarean sections, the erector spinae plane (ESP) block provided significantly longer-lasting pain relief compared to the transversus abdominis plane (TAP) block, with an average time to first rescue analgesia of 43.53 hours versus 12.07 hours.

The ESP block also resulted in a significantly lower total analgesic requirement, indicating it may be a more effective option for managing post-cesarean pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Erector spinae plane block and transversus abdominis plane block for postoperative analgesia in cesarean section: A prospective randomized comparative study. Malawat, A., Verma, K., Jethava, D., et al.[2023]

In a study involving 48 women undergoing open total abdominal hysterectomy, the erector spinae plane (ESP) block provided significantly better postoperative pain relief compared to the transversus abdominis plane (TAP) block, as indicated by lower Visual Analog Scale scores at multiple time points.

Patients receiving the ESP block required their first dose of morphine much later (14.81 hours) and consumed less morphine overall in the first 24 hours post-surgery compared to those who received the TAP block, suggesting that ESP blocks may be a more effective analgesic option.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bilateral Ultrasound-Guided Erector Spinae Plane Block Versus Transversus Abdominis Plane Block on Postoperative Analgesia after Total Abdominal Hysterectomy. Kamel, AAF., Amin, OAI., Ibrahem, MAM.[2020]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11964388/

The Utility of Erector Spinae Plane Blocks in Breast Surgery ESPB showed safe and reliable outcomes, significantly decreasing pain and opioid requirements compared with nonblocked individuals.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9933390/

Efficacy of erector spinae plane block for postoperative ... In this meta-analysis, performing ESP block significantly decreased VAS pain scores at all time-points. More importantly, ESP block prolonged ...

3. gazimedj.com gazimedj.com/articles/evaluation-of-postoperative-pain-in-patients-undergoing-erector-spinae-plane-block-in-breast-surgeries/gmj.2024.4225

Evaluation of Postoperative Pain in Patients Undergoing ... In this study, we evaluated the analgesic efficacy of erector spinae plane block (ESPB) in patients undergoing breast surgery. Methods. Our ...

4. clinicaltrials.gov clinicaltrials.gov/study/NCT05494502

Impact of Erector Spinae Plane Block on Chronic ... Erector spinae plane block (ESPB) provided excellent perioperative analgesia in patients undergoing breast surgery. Dexmedetomidine as an adjuvant of local ...

5. jag.journalagent.com jag.journalagent.com/agri/pdfs/AGRI-00087-EXPERIMENTAL_AND_CLINICAL_STUDIES-CIFTCI.pdf

Comparison of postoperative analgesic efficacy between ... Our results showed that RIB and ESPB provided equal levels of pain relief 24 h after breast surgery. Both ESPB and RIB provide effective ...

6. bmcanesthesiol.biomedcentral.com bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-021-01277-x

Analgesic efficacy and safety of erector spinae plane block in ... There was no statistically significant difference about complications after surgery related to ESPB. These results support the analgesic utility ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11732649/

Role of bilevel erector spinae with high thoracic block vs ... Analgesic efficacy and safety of erector spinae plane block in breast cancer surgery: a systematic review and meta-analysis. BMC Anesthesiol ...

8. signavitae.com signavitae.com/articles/10.22514/sv.2025.121

Erector spinae plane block for breast surgery All reviews consistently demonstrated that ESP block significantly reduced opioid consumption at 24 hours (mean reduction range: −4.93 to −7.67 morphine ...