• Lulu Qian, Hongye Zhang, Yongsheng Miao, Zongyang Qu, Yuelun Zhang, Bin Hua, and Zhen Hua.
• From the Department of Anesthesiology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China (LQ, HZ, YM, ZQ, ZH), Medical Research Centre, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China (YZ), Breast Centre, Department of Thyroid-Breast-Hernia Surgery, Department of General Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China (BH).
• Eur J Anaesthesiol. 2024 Oct 30.

BackgroundClinical comparisons between intertransverse process block (ITPB) and erector spinae plane block (ESPB) are lacking.ObjectiveThis study aimed to compare their blocking profile and clinical efficacy in breast cancer surgery.DesignRandomised, blinded, active-controlled superiority trial.SettingA tertiary hospital in China from 20 February to 31 July 2023.PatientsSixty-eight females undergoing unilateral breast cancer surgery.InterventionPatients were randomised to receive either ITPB performed at T2-6 (5 ml of 0.5% ropivacaine per level) or ESPB at T4 (25 ml of 0.5% ropivacaine). General anaesthesia and postoperative analgesia were standardised.Main Outcome MeasuresThe primary outcome was the number of blocked dermatomes at anterior T2-7, assessed 45 min after block completion, with a predefined superiority margin of 1.5 dermatomes. The important secondary outcome was the worst resting pain scores (11-point numerical rating scale) within 30 min in the recovery room, which was tested following a gatekeeping procedure. Other secondary outcomes included resting pain scores at various time points, use of rescue analgesics, opioid consumption, patient satisfaction, recovery quality score, and adverse effects within 24 h postoperatively.ResultsThe ITPB group showed a median [q1, q3] of 5 [4, 6] blocked dermatomes at anterior T2-7, whereas the ESPB group had 1 [0, 4], with a median difference of 4 (95% confidence interval (CI), 3 to 4); the lower 95% CI limit exceeded the predefined superiority margin of 1.5 (superiority P < 0.001). Worst resting pain scores within 30 min in the recovery room in the ITPB group were 1 [0, 2] vs. 3 [1, 4] in the ESPB group, with a median difference of -1 (95% CI, -2 to 0; P = 0.004). Patients in the ITPB group required fewer rescue analgesics within 30 min in the recovery room than did those in the ESPB group. No other clinically relevant results were observed in the secondary outcomes.ConclusionsAlthough ITPB demonstrated more consistent anterior dermatomal spread and improved immediate postoperative analgesia compared to ESPB, no additional benefits were identified for breast cancer surgery. Future studies may investigate the potential of ITPB for surgical anaesthesia.Trial Registrationwww.chictr.org.cn (ChiCTR2300068454).Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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