Effects of erector spinae plane block on postoperative pain in patients undergoing implant-based breast reconstruction for breast cancer: a randomized controlled trial
In brief
Erector spinae block reduces 24-hour opioid use by ~13 mg after implant breast reconstruction
In a randomized trial of 100 women undergoing mastectomy with implant reconstruction, a single-shot T5 erector spinae plane block with ropivacaine and dexmedetomidine lowered opioid consumption by about 13 mg in the first 24 hours and modestly improved early recovery scores, while pain scores were only slightly lower and did not reach the minimal clinically important difference. Larger studies are needed to confirm its clinical value.
- Journal
- Annals of medicine (Q1)
- Published
- 2 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Dandan Ling, Shiyou Wei, Qianping He, Yulin Li, Qianyun Xu, Wei Jiao, et al.
- PMID
- 42686359
- DOI
- 10.1080/07853890.2026.2722439
Why clinicians should know about it
- Picked for Dermatology (top studies of the week, 6 September 2026): High-quality evidence in a top journal
- Picked for Anesthesiology and Pain Medicine (top studies of the week, 6 September 2026): ESP block for implant‑based breast reconstruction pain
Abstract
BACKGROUND: Implant-based breast reconstruction after mastectomy causes acute pain. OBJECTIVE: To determine whether a single-shot T5 erector spinae plane block (ESPB) reduces postoperative pain. DESIGN: Single-center, RCT with allocation concealment; blinded assessors and statisticians. SETTING: Tertiary cancer center in China. PATIENTS: 100 adults scheduled for radical mastectomy with implant reconstruction were randomized (1:1); follow-up complete. INTERVENTION: Before induction, ESPB was given under ultrasound guidance at T5 with 30 mL of 0.375% ropivacaine plus dexmedetomidine 1 μg/kg; controls received no block. Standardized general anesthesia and postoperative PCA for both groups. MAIN OUTCOME MEASURES: Resting NRS at 6 h (MCID=1). Secondary outcomes were opioid consumption, quality of recovery, and PONV. RESULTS: ESPB did not significantly reduce resting pain at 6 h at the median (τ =0.50; adjusted difference -0.9; p = 0.08). At the upper tail, pain intensity was lower (τ = 0.75; -1.8; p <0.01). Repeated measures provided additional time-point information, improving estimation precision and test sensitivity. ESPB get lower pain scores at 6, 12, and 24 hours (all p <0.01). But, the 95% CI includes the MCID, the clinical benefit remains uncertain. Opioid use decreased at 24 h (-13.5 mg; p <0.01) and 48 h (-6.6 mg; p <0.01). Quality of recovery improved at 24 h (difference 5 points; p <0.01), but not later. No differences were observed in intraoperative hemodynamics or PONV. CONCLUSIONS: Single-shot T5 ESPB with perineural dexmedetomidine may reduce postoperative pain and opioid requirements and improve early recovery. Further large trials are warranted. Clinical relevance remains to be confirmed. TRIAL REGISTRATION: ClinicalTrials.gov NCT06143020.
Abstract as published, via PubMed.
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