Analgesic efficacy of erector spinae plane block versus retrolaminar block in patients undergoing major oncological breast surgery: A randomized controlled trial
Abstract
Background and Objective: Breast cancer is the most common cancer in females. Acute pain after major oncological breast surgery is an important concern. The erector spinae plane block (ESPB) and retrolaminar block (RLB) are ultrasound-guided techniques used for thoracoabdominal wall analgesia. We compared postoperative pain scores using the Numerical Rating Scale (NRS) at multiple time points and opioid consumption during the first 24 hours in patients undergoing major oncological breast surgery.
Methodology: This randomized controlled trial comprised 90 adult females aged 18 to 60 years who were scheduled for major breast surgery under general anesthesia, and had an American Society of Anesthesiologists (ASA) physical status of I or II. Exclusion criteria included bleeding or coagulation diathesis, prior breast surgery, known diabetes, a history of ischemic heart disease or heart block, pedicled flap reconstruction breast surgery, allergy to local anesthetics, local infection at the site of needle puncture, and emergency cases. Participants were randomized into two groups using a computer-generated randomization sequence. Group ESPB received an erector spinae plane block under ultrasound guidance, while Group RLB underwent a retrolaminar block under ultrasound guidance. During the intraoperative phase, rescue analgesia with morphine (dose adjusted according to body weight) was administered if the mean arterial pressure or heart rate increased by more than 20%.
Results: The mean NRS pain scores at 2, 4, 8, 12, and 24 hours were 1.24 ± 0.65, 1.38 ± 0.58, 1.49 ± 0.66, 1.56 ± 0.62, and 1.66 ± 0.67 in the RLB group, and 1.91 ± 0.76, 2.27 ± 0.72, 2.27 ± 0.84, 2.67 ± 0.83, and 2.82 ± 0.75 in the ESPB group, respectively. Mean opioid consumption was significantly lower in the RLB group compared with the ESPB group (2.67 ± 1.54 mg vs. 4.16 ± 1.17 mg; P < 0.001).
Conclusion: Following major breast surgery, both ultrasound-guided RLB and ESPB effectively relieved postoperative pain. However, RLB was associated with significantly lower pain scores and opioid consumption compared with ESPB, suggesting it may provide superior analgesia.
Keywords: Breast surgery, retrolaminar block, analgesia, erector spinae plane block, ultrasound-guided.
Citation: Naqvi SMZ, Mehdi SZ, Saleem H, Akram A, Iqbal A. Analgesic efficacy of erector spinae plane block versus retrolaminar block in patients undergoing major oncological breast surgery: A randomized controlled trial. Anaesth. pain intensive care 2026;30(1):95-100. DOI: 10.35975/apic.v30i1.3108
Received: September 13, 2025; Revised: October 26, 2024; Accepted: January 01, 2026
