Efficacy of pectoserratus plane block versus erector
spinae plane block on acute and chronic pain after
mastectomy: randomized clinical trial

Fabrício T. Mendonça; Marcus Alexandre B. de Aviz; Ana Paula S. Bezerra; Lucas G. Silva; Estefane E. Gaspar; Bárbara N. Terol; Lucianna R. e Silva; Liliana M. Andrade

doi:10.1016/j.bjane.2025.844691

Original Investigation

Efficacy of pectoserratus plane block versus erector spinae plane block on acute and chronic pain after mastectomy: randomized clinical trial

Eficácia do bloqueio do plano serrátil versus bloqueio do plano do eretor da espinha na dor aguda e crônica após mastectomia: ensaio clínico randomizado

Fabrício T. Mendonça, Marcus Alexandre B. de Aviz, Ana Paula S. Bezerra, Lucas G. Silva, Estefane E. Gaspar, Bárbara N. Terol, Lucianna R. e Silva, Liliana M. Andrade

http://dx.doi.org/10.1016/j.bjane.2025.844691 Braz J Anesthesiol, vol.75, n6, 844691, 2025

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Abstract

Objectives

To compare Pectoserratus Plane Block (PSPB) and Erector Spinae Plane (ESP) block regarding perioperative opioid consumption and chronic pain risk among women undergoing elective mastectomy.

Methods

Single-blind (patients), randomized (1:1) trial. The primary outcome was the composite measure deﬁned as the use of fentanyl intraoperatively or tramadol postoperatively. Secondary outcomes encompassed intraoperative hemodynamics, short (24h), medium (3 months) and long-term (6 months) postoperative pain intensity and complications.

Results

99 patients were randomized (50 in the PSPB group and 49 in the ESP block group). Of these, 93 patients had complete data for the primary outcome. Use of either fentanyl or tramadol was required for 20 of 47 patients (43%) in the PSPB group and 28 of 46 patients (61%) in the ESP block group (Relative Risk [RR] 0.70, 95% Conﬁdence interval [95% CI] 0.47‒1.05, p = 0.09). PSPB-treated patients had a lower risk of tramadol (RR = 0.31, 95% CI 0.12-0.77, p = 0.01) and dipyrone (RR = 0.60, 95% CI 0.39‒0.92, p = 0.02) consumption than ESP block-treated patients. PSPB lowered chronic pain risk at 3 months (RR = 0.66, 95% CI 0.47‒0.92, p = 0.02), with lower scores for the Short-Form McGill Pain Questionnaire (Mean Difference [MD] -2.55, 95% CI -4.31 to -0.78, p = 0.005) and the Douleur Neuropathique 4 Questions questionnaire (MD = -1.08, 95% CI -2.05 to -0.11, p = 0.03). By 6 months, pain outcomes were statistically comparable between groups. Hemodynamic variables and complications were comparable between groups.

Conclusion

PSPB and ESP block resulted in similar overall opioid consumption among women undergoing mastectomy. However, PSPB was associated with lower postoperative tramadol consumption.

Keywords

Analgesia; Chronic pain; Mastectomy; Nerve block; Opioid

Resumo

Objetivos

Comparar o bloqueio do plano serrátil (PSPB) e o bloqueio do plano do eretor da espinha (ESP) quanto ao consumo perioperatório de opioides e ao risco de dor crônica em mulheres submetidas à mastectomia eletiva.

Métodos

Ensaio randomizado (1:1), simples-cego (pacientes). O desfecho primário foi uma medida composta definida pelo uso de fentanil intraoperatório ou tramadol no pós-operatório. Os desfechos secundários incluíram variáveis hemodinâmicas intraoperatórias, intensidade da dor no pós-operatório imediato (24h), médio prazo (3 meses) e longo prazo (6 meses), além de complicações.

Resultados

Foram randomizadas 99 pacientes (50 no grupo PSPB e 49 no grupo ESP). Destas, 93 apresentaram dados completos para o desfecho primário. O uso de fentanil ou tramadol foi necessário em 20 de 47 pacientes (43%) no grupo PSPB e em 28 de 46 pacientes (61%) no grupo ESP (Risco Relativo [RR] = 0,70; Intervalo de Confiança [IC] 95% = 0,47–1,05; p = 0,09). As pacientes tratadas com PSPB apresentaram menor risco de uso de tramadol (RR = 0,31; IC 95% = 0,12–0,77; p = 0,01) e dipirona (RR = 0,60; IC 95% = 0,39–0,92; p = 0,02) do que as tratadas com bloqueio ESP. O PSPB reduziu o risco de dor crônica aos 3 meses (RR = 0,66; IC 95% = 0,47–0,92; p = 0,02), com escores menores no Questionário de Dor de McGill – Forma Curta (Diferença Média [MD] = -2,55; IC 95% = -4,31 a -0,78; p = 0,005) e no Questionário de Dor Neuropática DN4 (MD = -1,08; IC 95% = -2,05 a -0,11; p = 0,03). Aos 6 meses, os resultados de dor foram estatisticamente comparáveis entre os grupos. As variáveis hemodinâmicas e as complicações foram semelhantes.

Conclusão

Os bloqueios PSPB e ESP resultaram em consumo global semelhante de opioides em mulheres submetidas à mastectomia. No entanto, o PSPB foi associado a menor consumo pós-operatório de tramadol.

Palavras-chave

Analgesia; Dor crônica; Mastectomia; Bloqueio nervoso; Opioide

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Submitted date:
12/23/2024

Accepted date:
09/27/2025