Erector spinae plane block (ESPB) versus paravertebral plane block (PVB) in managing post-operative pain in breast cancer patients: a systematic review and meta-analysis

Abstract

Breast cancer surgeries remain the cornerstone of treatment for early-stage disease. Nonetheless, a substantial proportion of patients experience moderate-to-severe acute or chronic postoperative pain, adversely affecting quality of life and functional recovery. Regional anesthetic techniques have emerged as effective strategies for perioperative pain control. This study compares the erector spinae plane block (ESPB) and the thoracic paravertebral block (PVB) in breast cancer surgeries. Four databases were systematically searched for randomized controlled trials (RCTs) using ESPB and PVB in breast cancer surgeries. Primary extracted outcomes include post-operative morphine consumption, analgesia duration, resting and dynamic pain scores. Methodological quality was assessed using the ROB-2 tool, while data were pooled using the R software, Version 4.4.2. Nineteen RCTs reporting on 1527 patients were included. Postoperative morphine consumption, PONV incidence, and intraoperative fentanyl use were comparable in both groups. Similarly, pain scores at rest and movement reported no significant differences. The two techniques also demonstrated similar results regarding the number of patients requiring rescue analgesia and analgesia duration. ESPB was associated with a significant, however clinically negligent, shorter surgery duration compared to PVB [MD -0.04, 95% CI; -0.07 to 0.00, P = 0.023]. ESPB and PVB provide comparable analgesic efficacy and perioperative outcomes in breast cancer surgeries. ESPB may offer a shorter surgical duration, supporting its use as a simpler yet equally effective alternative to PVB, however this must be taken cautiously.