Erector spinae plane block versus intercostal block in postoperative pain management of mastectomy

Abstract

Objectives: To compare the postoperative analgesic efficacy between erector spinae plane block and intercostal block following mastectomy.

Study design: Randomized controlled trial.

Place and duration of study: Fauji Foundation Hospital, Rawalpindi, from Nov-2025 to Jan-2026.

Methods:
Sixty women undergoing elective mastectomy were randomized into two equal groups. Women in group ICNB received intercostal nerve block, while those in group ESPB received erector spinae plane block, using 0.125% bupivacaine (20 mL) under ultrasound (US) guidance. Numeric Rating Scale was used to assess the postoperative pain where the primary outcome was the pain score at 24 hours. Secondary outcomes included time to need first rescue analgesia and the total opioid consumption during 24 hours.

Results:
The mean age of women was 59.32±3.12 years which ranged from 51-65 years. The results showed a significantly lower pain score at 24 hours in Group ESPB compared to Group ICNB (2.27±0.58 vs 3.03±0.85, p<0.01) while this difference was also significantly lower at 6 hours (p<0.01), and 12 hours (p<0.01). Similarly, a prolonged duration of analgesia and reduced opioid consumption was demonstrated in Group ESPB compared to Group ICNB.

Conclusion:
Erector spinae plane block provides superior postoperative analgesia with longer pain relief and reduced opioid requirements compared to intercostal block in women undergoing mastectomy.

Keywords: Erector spinae plane block, Intercostal nerve block, Mastectomy, Postoperative pain.