【罂粟摘要】胸神经阻滞用于隆胸手术：一项随机、双盲、双中心对照试验
胸神经阻滞用于隆胸手术：一项随机、双盲、双中心对照试验
贵州医科大学高鸿教授课题组
翻译：任文鑫 编辑：佟睿 审校：曹莹
胸神经阻滞已被提议用于乳腺癌手术期间和术后的镇痛，但在乳房美容手术中数据存在矛盾。该试验验证了在隆胸术后增加切口前胸神经阻滞优于单独的全身多模式镇痛方案。第二个假设是，在接下来的几天内，术后阿片类的消耗量将减少，并对两种结果产生长期影响。
73名在全身麻醉下接受美容隆胸手术的成年女性患者被随机分配接受胸神经阻滞与不进行阻滞。两组均接受标准护理，仅使用常规多模式镇痛，包括系统对乙酰氨基酚和非甾体抗炎药。主要观察指标的测量方法是在拔管后的前6小时的最大数值评分量表。次要观察指标包括术中瑞芬太尼用量和从拔管到第5天：最大数值评分量表、术后累积阿片类药物用量和术后阿片类药物副作用，以及第5天记录患者满意度。
与对照组相比，胸神经阻滞组在前6h的最大数值评分量表得分较低（3.9±2.5 vs.5.2±2.2）；差异：–1.2[95%置信区间，–2.3至–0.1]；P=0.036）。胸神经阻滞组在第1天至第5天之间的最大数值评分量表较低(2.2±1.9对3.2±1.7；P=0.032)。胸神经阻滞组从第6小时到第1天（0.0[0.0-21.0]vs.21.0[0.0-31.5]mg，P=0.006）和第1-5天（0.0[0.0-21.0]vs.21.0[0.0-51]mg，P=0.002）的阿片类药物总消耗量（口服吗啡当量）较低。
胸神经阻滞结合多模式镇痛，可有效缓解隆胸术后的围手术期疼痛，并可减少术后前5天的阿片类药物消耗。
Yassir Aarab, Severin Ramin, Thomas Odonnat,et al.Pectoral Nerve Blocks for Breast Augmentation Surgery: A Randomized, Double-blind, Dual-centered Controlled Trial.ANESTHESIOLOGY 2021; 135:442–53.
Pectoral Nerve Blocks for Breast Augmentation Surgery: A Randomized, Double-blind, Dual-centered Controlled Trial
ABSTRACT
Background: Pectoral nerve blocks have been proposed for analgesia during and after breast cancer surgery, but data are conflicted in aesthetic breast surgery. This trial tested the primary hypothesis that adding a preincisional pectoral nerve block is superior to systemic multimodal analgesic regimen alone for pain control after breast augmentation surgery. A second hypothesis is that rescue opioid consumption would be decreased with a long-lasting effect for both outcomes during the following days.
Methods: Seventy-three adult female patients undergoing aesthetic breast augmentation surgery under general anesthesia were randomly allocated to receive a pectoral nerve block versus no block. Both groups received standard care with protocolized multimodal analgesia alone including systematic acetaminophen and nonsteroidal anti-inflammatory drugs. The primary outcome measure was the maximal numerical rating scale in the first 6 h after extubation. Secondary outcomes included intraoperative remifentanil consumption and from extubation to day 5: maximal numerical rating scale, postoperative cumulative opioid consumption and postoperative opioid side effects, and patient satisfaction recorded at day 5.
Results: The maximal numerical rating scale score in the first 6 h was lower in the pectoral nerve block group compared with the control group (3.9 ± 2.5 vs. 5.2 ± 2.2; difference: –1.2 [95% CI, –2.3 to –0.1]; P = 0.036). The pectoral nerve block group had a lower maximal numerical rating scale between days 1 and 5 (2.2 ± 1.9 vs. 3.2 ± 1.7; P = 0.032). The cumulative amount of overall opioids consumption (oral morphine equivalent) was lower for the pectoral nerve block group from hour 6 to day 1 (0.0 [0.0 to 21.0] vs. 21.0 [0.0 to 31.5] mg, P = 0.006) and from days 1 to 5 (0.0 [0.0 to 21.0] vs. 21.0 [0.0 to 51] mg, P = 0.002).
Conclusions: Pectoral nerve block in conjunction with multimodal analgesia provides effective perioperative pain relief after aesthetic breast surgery and is associated with reduced opioid consumption over the first 5 postoperative days.
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