In modified radical mastectomy operation erector spina plan block effect on postoperative pain and anxiety

Aim: The primary aim of this study is; to investigate the effect of erector spinae plane block on postoperative pain and anxiety in modified radical mastectomy operation. Material and Methods: Modified radical mastectomy operation was planned under general anesthesia due to breast cancer and in the pre-anesthesia evaluation; 66 subjects, aged 18-65, with ASA classification I-II, and who signed the informed consent form, were included in the study. Patients were determined as the study group and control group by lottery method. This procedure was performed 24 hours before surgery. The groups were determined as the ESPB group (n=33) for those who received blocks, and as the Control group (n=33) for those who did not receive blocks. Preoperative demographic data of the patients were recorded. The anxiety levels of all cases were evaluated with the STAI-I (State Anxiety Inventory) and STAI-II (Trait Anxiety Scale) anxiety scales, which consist of 20 items each, within 24 hours before the surgery. Before the surgery, thoracic ESPB was performed on the study group using a local anesthetic solution containing 5 ml of 0.5% bupivacaine (25 mg) + 5 ml of physiological saline (10 ml in total) with a 22 G, 50 mm block needle under USG guidance at the T4 level before being anesthetized. All cases were anesthetized with a standard general anesthesia procedure, routine case follow-ups were performed, and PCA containing IV analgesics (NSAIDs) and tramadol was administered 15 minutes before the end of the operations, and PCA infusion continued for 24 hours. In the postoperative follow-up of the patients, VAS values at the 6th, 12th and 24th hours, tramadol consumption amounts with PCA, bolus numbers with PCA, heart rate, systolic and diastolic blood pressures, additional analgesic requirements and STAI-I (State Anxiety Inventory) at the 24th hour.) and STAI-II (Trait Anxiety Inventory) anxiety scales and anxiety states were recorded. Results: When the demographic data of both groups were compared, they were found to be similar. Postoperative 6th, 12th and 24th hour VAS values, 24-hours total tramadol consumption amount and bolus number by PCA, and additional dose analgesic need were determined to be statistically significantly higher in the control group. The postoperative anxiety levels of the patients in the study group who underwent ESPB were found to be statistically significantly lower than the results of the STAI-I and STAI-II (State-Trait Anxiety Scale) scales we applied. When the heart rate, systolic and diastolic blood pressures of the patients were compared during their follow-up, no statistically significant difference was detected. Conclusion: In our study, it was found that ESPB reduced intravenous analgesic and opioid consumptions in the first 24 hours postoperatively and reduced VAS values and postoperative anxiety levels in patients who underwent modified radical mastectomy. We think that ultrasonography-guided ESPB is an alternative, safe and effective technique to provide analgesia and reduce opioid consumption in the postoperative period in patients undergoing breast surgery. Therefore, ESPB application may be an alternative to traditional analgesic methods. However, due to the limited number of patients and clinical studies in the literature, it was concluded that the number of patients and studies should be increased.