Sidiropoulou Tatiana, Buonomo Oreste, Fabbi Eleonora, Silvi Maria Beatrice, Kostopanagiotou Georgia, Sabato Alessandro Fabrizio, Dauri Mario
Second Department of Anesthesiology, University of Athens, Attikon Hospital, Athens, Greece.
Anesth Analg. 2008 Mar;106(3):997-1001, table of contents. doi: 10.1213/ane.0b013e31816152da.
The efficacy of continuous wound infiltration with local anesthetic has not been compared with that of thoracic paravertebral block (PVB) after breast surgery. In this study, we evaluated the analgesic efficacy and morphine consumption of the two techniques after mastectomy.
Forty-eight patients undergoing modified radical mastectomy with axillary dissection were randomly assigned to either a preoperative PVB with 20 mL of ropivacaine 0.5% (group PVB) or a continuous ropivacaine 0.5% infusion (CRI) at a 2 mL/h rate for each of two multilumen catheters placed subcutaneously at the end of the procedure (group CRI). The catheters were left in place for 24 h postoperatively. A standardized general anesthetic was administered to all patients. Postoperative morphine consumption, pain scores and painful restricted movement of the shoulder for 24 h postoperatively as well as incidence of adverse events, including postoperative nausea and vomiting, were recorded.
Morphine consumption was similar between groups (PVB: 42.6 +/- 11 vs CRI: 38.7 +/- 11 mg in 24 h, P = 0.225). Absolute pain scores were low in both groups. Four hours after surgery, group PVB showed a significant reduction in postoperative pain (PVB: 0 [0-10] vs CRI: 0 [0-30], P = 0.002) and reduced painful restricted movement (P = 0.004), whereas the CRI group had lower pain scores (PVB: 10 [0-30] vs CRI: 0 [0-20], P = 0.034) and painful restricted movement (P = 0.043) 16 and 24 h (PVB: 10 [0-30] vs CRI: 0 [0-30], P = 0.012) after surgery. Postoperative nausea and vomiting was significantly more frequent in the CRI group (P = 0.017).
Continuous wound infiltration of local anesthetics is an effective alternative to paravertebral analgesia after mastectomy with axillary dissection.
乳房手术后，局部麻醉药持续伤口浸润的效果尚未与胸段椎旁阻滞（PVB）进行比较。在本研究中，我们评估了乳房切除术后这两种技术的镇痛效果和吗啡消耗量。
48例行改良根治性乳房切除术并腋窝清扫术的患者被随机分为两组，一组为术前给予20 mL 0.5%罗哌卡因的PVB（PVB组），另一组为在手术结束时于皮下放置两根多腔导管，以2 mL/h的速率持续输注0.5%罗哌卡因（CRI组）。导管术后留置24小时。所有患者均接受标准化全身麻醉。记录术后24小时吗啡消耗量、疼痛评分、肩部疼痛性活动受限情况以及不良事件发生率，包括术后恶心和呕吐。
两组间吗啡消耗量相似（PVB组：24小时内42.6±11 mg，CRI组：38.7±11 mg，P = 0.225）。两组的绝对疼痛评分均较低。术后4小时，PVB组术后疼痛显著减轻（PVB组：0[0 - 10]，CRI组：0[0 - 30]，P = 0.002），疼痛性活动受限减少（P = 0.004），而CRI组在术后16小时和24小时疼痛评分较低（PVB组：10[0 - 30]，CRI组：0[0 - 20]，P = 0.034），疼痛性活动受限也较少（P = 0.043，PVB组：10[0 - 30]，CRI组：0[0 - 30]，P = 0.012）。CRI组术后恶心和呕吐明显更频繁（P = 0.017）。
对于行腋窝清扫术的乳房切除术后患者，局部麻醉药持续伤口浸润是椎旁镇痛的有效替代方法。
