Analgesic effect of adding calcitonin to bupivacaine in erector spine plane block for breast surgery, a double blind randomised study

Background Surgery for breast malignancy is linked to severe perioperative discomfort. Pain management reduces the need for opioids and general anesthesia. The "erector spinae plane block" (ESPB) recently became an effective choice in this concern. Our trial assessed the effectiveness of calcitonin as an LA adjuvant in ESPB for pain control in patients underwent cancer breast surgery. Patients and Methods One hundred and thirty patients were randomly allocated into two groups, BC and B. BC group received ESPB with 20 mL of bupivacaine 0.25% in addition to 50 IU of calcitonin in 2 mL of saline, while the other group received the same bupivacaine dose in addition to saline (2 ml). Main outcome was time for first rescue analgesia. Secondary outcomes included 24-h total morphine consumption postoperatively, postoperative VAS scores, levels of inflammatory cytokines, total intraoperative fentanyl consumption, and side effects. Results The period before the first-time analgesia was required was extended (12.18 +/- 4.969 h vs 6.60 +/- 3.116 h, P < 0.001), with less postoperative opioid consumption in the BC group (6.40 +/- 1.876 mg vs 7.74 +/- 2.117 mg, P < 0.001). Pain scores and the number of patients who asked for painkillers after surgery were less in the BC group. Patients in the BC group had a significant decline in serum inflammatory cytokines (TNF-alpha, IL-6), while IL-10 showed a significant increase in the BC group (P < 0.001). Intraoperative fentanyl and postoperative adverse effects recorded were statistically comparable in the two studied groups. Conclusion The addition of calcitonin to bupivacaine in the ESPB block can give an extended analgesic effect with lower inflammatory cytokine indicators.