Comparing postoperative pain control after modified radical mastectomy: a pilot study of ultra-sound guided erector spinae plane block vs intraoperative tramadol administration in oncology patients

Abstract

Purpose: This study aimed to compare the effectiveness of ultrasound-guided erector spinae plane block (ESPB) with intraoperative Tramadol for postoperative pain management after modified radical mastectomy (MRM). The primary focus was on pain intensity within the first 24 h, while secondary outcomes included the need for rescue analgesia, nausea, vomiting, and patient satisfaction. Methods: In this retrospective cohort study, 49 female patients (ASA I-II, aged 30–80) who underwent MRM from 2021 to 2023 were analyzed. Patients were divided into two groups: one receiving ESPB preoperatively (25 patients) and the other receiving Tramadol during surgery (24 patients). Pain levels were measured using the Numeric Rating Scale (NRS), and data on rescue analgesia, vital signs, nausea, vomiting, and patient satisfaction were collected. Results: The ESPB group reported significantly lower pain levels during the first six postoperative hours (NRS scores of 0 vs. 3; p = 0.005), along with a reduced need for rescue analgesia (88% vs. 54.2%; p = 0.010). Moreover, patient satisfaction was higher in the ESPB group (64% vs. 37.5%; p = 0.03). The intraoperative heart rate was also lower in the ESPB group (65.3 vs. 72.0 bpm; p = 0.030). No significant differences were found in nausea, vomiting, or length of hospital stay. Conclusion: Overall, ESPB demonstrates superior early postoperative pain control and improved patient satisfaction compared to Tramadol. Further studies are needed to confirm these findings. © The Author(s) 2025.