The aim of this study is to compare the analgesic efficacy of multilevel erector spinae plane block (ESPB) vs thoracic epidural in modified radical mastectomy (MRM) regarding duration of analgesia, postoperative opioid consumption, effect on intraoperative fentanyl consumption, postoperative numerical pain rating scale and quality of life for the next 6 months.
Female patients age ≥ 18 years and ≤ 65 Years.
Type of surgery; Modified Radical Mastectomy (MRM)
Physical status ASA II, III.
Body mass index (BMI): > 20 kg/m2 and < 35 kg/m2.
Patient refusal.
Allergy or a contraindication to the drug used in the study, e.g. local anesthetics, opioids.
History of psychological disorders.
History of chronic pain.
Parallel
Erector spinae plane block (ESPB)
DrugErector spinae plane block (ESPB) using multilevel injections of bupivacaine 0.25%. We will inject 15ml at the level of T2 and 15ml at the level of T5.
Thoracic epidural block
DrugThoracic epidural block at level of T5 -T6 using 10 ml of bupivacaine 0.25% as a bolus followed by 5 ml bupivacaine 0.25% every 1-2 hours depending on the duration of surgery and the response of the patient.
The average duration of analgesia
The average duration of analgesia will be recorded from the end of surgery till the first dose of morphine administrated.
The total amount of morphine
Patient will be discharged to the ward then rescue analgesia will be given in the form of IV morphine 3 mg boluses if the patient reported Numeric Pain Rating Scale ≥ 4. The total amount of morphine given in 24 hours will be recorded for the two groups.
Incidence of postmastectomy pain syndrome
Incidence of postmastectomy pain syndrome at 1, 3, and 6 months postoperatively will be recorded.
The total amount of fentanyl
Fentanyl 1 μg/kg will be given if the mean arterial blood pressure or heart rate rises above 20% of the baseline levels.
Heart rate (HR)
Heart rate will be noted at 4, 8, 12, 16, 20, and 24 hours postoperatively
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