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Bilateral reduction mammoplasty is one of the most commonly performed breast surgery. The Postoperative pain following it should be minimized.
Opioid administration for acute pain after reduction mammoplasty surgery has many side effects. Regional block techniques such as paravertebral block and thoracic epidural anesthesia have possible complications and technical difficulties.
The new alternative regional techniques such as erector spinae plane block and rhomboid intercostal plane block are clinical trials for providing a safe, easy, and painless anesthetic procedure with adequate postoperative analgesia for a large section of patients undergoing thoracic surgeries.
Reduction mammoplasty is the gold standard procedure for symptomatic breast hypertrophy and it is also used for contralateral breast symmetrisation following breast cancer surgery. Symptomatic hypermastia affects the quality of life of millions of women worldwide. The most frequent symptoms shown by more than two-thirds of patients are shoulder grooving, and back, shoulder, and neck pain. Reduction mammoplasty proved to be an effective treatment, both aesthetically and functionally, with a demonstrated consistently high patient satisfaction.
Optimal pain management is an essential component of enhanced recovery after surgery protocols that are becoming standard of care because they have been shown to reduce postoperative complications and expedite recovery. However, postoperative pain is still inadequately managed. Opioids remain the mainstay of perioperative pain management, despite well-recognized adverse events including nausea, vomiting, pruritus, and respiratory depression.
Regional anesthesia has been believed as one of the formats for effective perioperative pain control. Plane blocks such as the serratus anterior plane (SAP) block, pectoral nerve block, and erector spinae plane block have gained popularity during multimodal analgesia after various surgical procedures.
The erector spinae plane block (ESPB) was initially introduced by Forero et al. in 2016 and offers extensive analgesia in thoracic surgery. It can be used as a substitute for PVB because it is less intrusive, simpler, and safer to apply plane blocks that are applied in the plane of the spine's erector muscles.
Rhomboid intercostal block (RIB) was described in 2016 as an alternative to thoracic epidural analgesia. The local anesthetic agent is delivered into the plane between the rhomboid major and intercostal muscles. That provides good analgesia for the anterior and posterior hemithorax.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| control group | Placebo Comparator | patients will receive general anesthesia |
|
| E group | Active Comparator | patients will receive Erector spinae plane block |
|
| R group | Active Comparator | patients will receive rhomboid intercostal nerve block |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| general anesthesia | Procedure | patients will receive general anesthesia. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Time to first dose of rescue analgesia | is the time from the end of operation to patient reporting VAS ≥ 3. Thereafter, rescue analgesia in the form of 0.1mg/kg IV of nalbuphine will be injected. | in the first postoperative 24 hours |
| Total nalbuphine consumption | total dose of nalbuphine rescue analgesic that the patient required postoperatively | in the first 24 hours postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| changes of pain assessment | visual analogue scale will be recorded at rest and movement | at 1hour, 3,6,12, 24 hours postoperatively |
| non invasive blood pressure | changes of hemodynamics |
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Inclusion Criteria:
Exclusion Criteria:
This surgery is only performed for women
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| Name | Affiliation | Role |
|---|---|---|
| Shereen E Abd Ellatif, M.D. | Faculty of medicine, zagazig university | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculty of medicine, zagazig university | Zagazig | Alsharqia | 4115 | Egypt | ||
| Shereen E Abd Ellatif |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31198256 | Background | Gad M, Abdelwahab K, Abdallah A, Abdelkhalek M, Abdelaziz M. Ultrasound-Guided Erector Spinae Plane Block Compared to Modified Pectoral Plane Block for Modified Radical Mastectomy Operations. Anesth Essays Res. 2019 Apr-Jun;13(2):334-339. doi: 10.4103/aer.AER_77_19. | |
| 34640438 | Background | Viscardi JA, Oranges CM, Schaefer DJ, Kalbermatten DF. Reduction Mammoplasty: A Ten-Year Retrospective Review of the Omega Resection Pattern Technique. J Clin Med. 2021 Sep 27;10(19):4418. doi: 10.3390/jcm10194418. |
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planned after the completion of the study and publication
planned after the completion of the study and publication
contact with principal investigatoR
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computer generating random numbers, the patients will be allocated into three equal groups: Group C: (control group) patients will receive general anesthesia. Group E: patients will receive an Erector spinea plane block with 20 ml of bupivacaine 0.25% on each side followed by general anesthesia.
Group R: patients will receive rhomboid intercostal nerve block with 20 ml of bupivacaine 0.25% on each side followed by general anesthesia.
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Double (Participant, Outcomes Assessor) double-blinded(participants and outcome assessors)
| Erector spinae plane block | Procedure | patients will receive Erector spinae plane block with 20 ml of bupivacaine 0.25% on each side followed by general anesthesia. |
|
| a rhomboid intercostal nerve block | Procedure | patients will receive a rhomboid intercostal nerve block with 20 ml of bupivacaine 0.25% on each side followed by general anesthesia. |
|
| Bupivacaine | Drug | 20 ml of bupivacaine 0.25% |
|
| immediately prior to surgery, immediately after skin incision, 15,30,60,120,180,240 min intraoperatively and at end of surgery |
| Zagazig |
| Alsharqia |
| 4115 |
| Egypt |
| 27291611 | Background | Elsharkawy H, Saifullah T, Kolli S, Drake R. Rhomboid intercostal block. Anaesthesia. 2016 Jul;71(7):856-7. doi: 10.1111/anae.13498. No abstract available. |
| 36928313 | Background | Tunay DL, Ilginel MT, Karacaer F, Biricik E, Tabakan I, Ozmete O. Bilateral Ultrasound-Guided Erector Spinae Plane Block for Perioperative Analgesia in Breast Reduction Surgery: A Prospective Randomized and Controlled Trial. Aesthetic Plast Surg. 2023 Aug;47(4):1279-1288. doi: 10.1007/s00266-023-03315-0. Epub 2023 Mar 16. |
| 30851503 | Background | Yayik AM, Ahiskalioglu A, Ates I, Ahiskalioglu EO, Cinal H. Ultrasound guided bilateral rhomboid intercostal block for breast reduction surgery. J Clin Anesth. 2019 Nov;57:38-39. doi: 10.1016/j.jclinane.2019.03.001. Epub 2019 Mar 6. No abstract available. |
| 41652322 | Derived | Abd Ellatif SE, Wahdan RA, Wahdan RA, Ibrahim ES, Galal Eldin AM. Rhomboid intercostal block versus erector spinae plane block for perioperative analgesia in patients undergoing reduction mammoplasty: a prospective randomized study. BMC Anesthesiol. 2026 Feb 6;26(1):138. doi: 10.1186/s12871-025-03567-0. |
| ID | Term |
|---|---|
| D000377 | Agnosia |
| ID | Term |
|---|---|
| D010468 | Perceptual Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D000768 | Anesthesia, General |
| D002045 | Bupivacaine |
| ID | Term |
|---|---|
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
| D000588 | Amines |
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