Bilateral Ultrasound-Guided Erector Spinae Plane Block versus Serratus Anterior Plane Block for Postoperative Analgesia in Breast Reduction Surgery: A Prospective, Randomized, Outcome Assessor- Blinded, Controlled Trial

Why clinicians should know about it

• Picked for Plastic and Reconstructive Surgery (paper of the day, 21 October 2026): Bilateral ESPB reduced 24‑h tramadol consumption

Abstract

BACKGROUND: Breast reduction surgery is a common aesthetic procedure associated with significant postoperative pain. Effective analgesia plays an important role in reducing opioid consumption, minimizing adverse effects, facilitating postoperative recovery, and improving patient satisfaction. Fascial plane blocks have recently gained popularity for breast surgery. This randomized study aimed to compare the effects of bilateral erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) on postoperative analgesia in patients undergoing breast reduction surgery. METHODS: Seventy female patients undergoing bilateral breast reduction surgery were randomly allocated into two groups: ESPB (Group ESPB, n = 35) and SAPB (Group SAPB, n = 35). Blocks were performed bilaterally under ultrasound guidance, with 20 mL of 0.25% bupivacaine each side, 30 min before surgery. All procedures were performed using the wise-pattern reduction mammoplasty technique with a superiomedial pedicle by the same surgical team. Postoperative analgesia included intravenous paracetamol, ibuprofen, and intravenous tramadol patient-controlled analgesia (PCA). Primer outcome was 24-h tramadol consumption through intravenous patient-controlled analgesia (PCA). Secondary outcomes included time to first analgesic requirement from PCA, postoperative pain scores (NRS), intraoperative remifentanil consumption, perioperative variables, length of hospital stay, and adverse effects. RESULTS: Primary-outcome data were available for 35 SAPB and 34 ESPB patients. Mean 24-hour tramadol consumption was 70.0 ± 37.7 mg with SAPB and 53.2 ± 29.1 mg with ESPB (mean difference, SAPB minus ESPB, 16.8 mg; 95% confidence interval, 0.5-33.0 mg; p = 0.043). Median time to first analgesic requirement was 420 min with SAPB and 630 min with ESPB (log-rank p < 0.001). Pain scores did not differ significantly. Nausea occurred in five SAPB patients and no ESPB patients (Fisher's exact p = 0.054); vomiting occurred in either group. Bradycardia occurred in one ESPB group patient (p = 1). CONCLUSIONS: In this single-center trial, ESPB was associated with lower 24-h tramadol consumption and a longer time to first PCA demand than SAPB, while pain scores were comparable. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as published, via PubMed.