Assessment of the quality of recovery in patients receiving erector spinae plane block compared to local infiltration in patients undergoing major oncological breast surgery.

Abstract

Objective: To compare the Quality of Recovery (QoR-15) scores and postoperative opioid consumption in patients undergoing major oncological breast surgery receiving the Erector Spinae Plane (ESP) block versus local infiltration (LI). Study Design: Prospective Randomized Controlled Trial. Setting: Department of Anaesthesia and Pain Management, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Period: March 1, 2025 to September 30, 2025. Methods: Seventy female patients aged 18–65 years, ASA physical status I or II, undergoing unilateral major oncological breast surgery were randomized into two equal groups (n=35 each). Group A received an ultrasound-guided ESP block at T2–T6 using bupivacaine 0.375% (30 ml), and Group B received local infiltration at the incision site with bupivacaine 0.375% (30 ml) with standard general anaesthesia. The primary outcome was the QoR-15 global score assessed at 48 hours postoperatively. Secondary outcome included postoperative opioid consumption. Data were analysed using the Mann–Whitney U test, with p < 0.05 considered statistically significant. Results: Both groups were comparable in baseline demographic and clinical characteristics. At 48 hours, the ESP group demonstrated significantly higher QoR-15 global scores compared to the LI group (median [IQR]: 145.9 [144.3–149.0] vs. 115.8 [112.9–118.0] (p < 0.0001). Significant improvements in the ESP group were observed across all 15 individual QoR-15 items. 24-hour postoperative morphine consumption was significantly lower in the ESP group compared to the LI group (1.71 ± 0.79 mg vs. 3.26 ± 0.70 mg; p < 0.0001). Conclusion: The ESP block significantly improves quality of recovery at 48 hours and reduces postoperative opioid consumption compared to local infiltration in patients undergoing major oncological breast surgery.