Feasibility of combined ultrasound guided interscalene and erector spinae plane block for regional anesthesia in modified radical mastectomy with axillary lymph node dissection: A pilot study

Background
In patients at high risk, regional anesthesia (RA) is a viable substitute for general anesthesia (GA). For a modified radical mastectomy that included axillary lymph node dissection (MRM-ALND), we assumed that a combination erector spinae plane block (ESPB) and interscalene block (IBPB) could offer a sufficient anesthesia.
Methods
After clinical trial registration (No. NCT04239716), this pilot study included thirteen consecutive female, 40–85 years old, and scheduled for MRM-ALND. Patients received ESPB at T4 level (5 ml of 2% lidocaine, 10 ml of 0.5% bupivacaine, and 5 ml of normal saline), IBPB (5 ml each of 2% lidocaine and 0.5% bupivacaine), and sedation with dexmedetomidine. The primary aim was to assess the success rate of our technique as a sole anesthesia for MRM-ALND in high-risk patients. Secondary outcomes included intraoperative vital signs measurements. Postoperative measurements were numeric rating scale (NRS) score, analgesic duration, the consumption of morphine, patients’ satisfaction, and adverse effects.
Results
Our technique succeeded in 11 out of 13 patients. In whom RA were succeeded, the analgesia lasted 360–720 minutes, they received morphine 3–9 mg and had low NRS scores. The two failure cases received GA, the analgesia lasted 60–120 minutes postoperative, they received morphine 9 mg and had high NRS scores. The reduction of hemodynamic parameters intraoperative responded to reduce dexmedetomidine infusion rate. Two patients had postoperative vomiting treated with ondansetrone.
Conclusions
The combined ESPB and IBPB could be utilized as an alternative to GA for MRM-ALND, which reduced the potential risks of GA in high-risk patients; furthermore, it provides satisfactory postoperative analgesia with limited opioid consumption.