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 p p p p 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.