Objective: Thoracic paravertebral block (TPVB) and Erector spinae plane block (ESPB) are the most preferred regional analgesia techniques for breast surgeries. However, the literature is still lack of reliable evidence to prove superiority of one over another. We hypothesized that TPVB would provide better pain control for the acute postoperative period.

Material and Methods: In this retrospective cohort study, macromastia patients who underwent bilateral reduction mammaplasty surgery were grouped according to the regional technique performed prior to general anesthesia induction that are provided with 0.375% bupivacaine bilaterally (TPVB or ESPB). Presurgery (10th min, 20th min, and 30th min) and postoperative number of dermatomal sensory block, and postoperative pain scores were screened which referred to postoperative 0 minute,1st hour, 2nd hour, 4th hour, 6th hour, 12th hour, 24th hour and 48th hour examination. Intraoperative and postoperative analgesic administration, and comfort parameters such as time-to-first pain, nausea-vomiting (PONV) incidence, sleep duration, complications and patient/surgeon satisfaction scores were also investigated.

Results: Total 58 patients were screened. Pain scores were lower in TPVB group for the postoperative first 2 hours (P<0.05). TPVB blocked more dermatomes during postoperative 1st day (P<0.05) whereas postoperative tramadol consumption were similar with both blocks (P>0.05). On the other hand, postoperative 2nd day paracetamol consumption was less with TPVB (P=0.03). Time-to-first pain and sleep duration on the postoperative 1st day was shorter with ESPB (P<0.05). Conclusions: Thoracic paravertebral block represents better analgesic features than erector spinae plane block for reduction mammaplasty. However, ESPB may still be considered to provide favorable analgesia.