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

Trial Summary

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.

What data supports the effectiveness of this treatment for pain relief after breast reconstruction surgery?

Research shows that both the erector spinae plane (ESP) block and the transversus abdominis plane (TAP) block are effective in reducing pain after various surgeries, including abdominal and breast surgeries. The ESP block, in particular, has been successfully used for pain control in breast surgery, which suggests it could be effective for breast reconstruction surgery as well. ^{1 2 3 4 5}

Are ESPB and TAP blocks safe for humans?

Both Erector Spinae Plane (ESP) blocks and Transversus Abdominis Plane (TAP) blocks are considered safe for humans and have been used effectively for pain relief after various surgeries, including cesarean sections and abdominal surgeries. ^{1 2 3 4 5}

How does the ESPB treatment differ from other treatments for pain relief after breast reconstruction surgery?

The erector spinae plane block (ESPB) is a newer regional anesthesia technique that is simpler and potentially safer than other methods like the paravertebral block, and it provides effective pain relief by targeting nerves in the back. This makes it unique compared to traditional pain relief methods, which may not offer the same ease of administration or safety profile. ^{1 2 3 5 6}

What is the purpose of this trial?

Breast cancer is the second most common cancer diagnosed in American women . For patients who have undergone surgical mastectomy, autologous breast reconstruction is an alternative option to breast implants. Deep Inferior Epigastric Perforator (DIEP) flaps are the gold standard for autologous breast reconstruction . Effective pain control following surgery is imperative and ultrasound-guided bilateral transversus abdominis plane blocks (TAPs) with the infiltration of local anesthetics, such a bupivacaine are a common regional technique of choice . A newer described technique, bilateral Erector Spinae Plane blocks (ESPBs) (which also are an infiltration of local anesthetic) present as an alternative approach for post-operative analgesia. ESPBs have been proven efficacious in reducing intra- and post-operative opioid requirements, lessening the need for rescue analgesics in other similar surgical procedures. The hypothesis is that preoperative bilateral ESPBs could provide equivalent pain control as a regional analgesic for patients undergoing DIEP flap surgery when compared to preoperative bilateral TAPs

Eligibility Criteria

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

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

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

Timeline

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)

Treatment Details

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.

Participant Groups

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+

Findings from Research

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 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]

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 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]

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]

References

1. United States 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. [2022]

2. England 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. [2022]

3. United States 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. [2022]

4. India 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. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

Bilateral Ultrasound-Guided Erector Spinae Plane Block Versus Transversus Abdominis Plane Block on Postoperative Analgesia after Total Abdominal Hysterectomy. [2020]

6. Italy pubmed.ncbi.nlm.nih.gov

Paravertebral block versus erector spinae plane block for analgesia in modified radical mastectomy: a randomized, prospective, double-blind study. [2023]