Sleth J-C, Servais R, Saizy C
Polyclinique Saint-Roch, 43, rue du Faubourg-Saint-Jaumes, 34967 Montpellier cedex 2, France.
Ann Fr Anesth Reanim. 2008 Nov;27(11):941-4. doi: 10.1016/j.annfar.2008.08.011. Epub 2008 Nov 11.
To assess safety and efficacy of tumescent infiltration of the supraclavicular nerve and the anterior and lateral branches of the intercostal nerves in major breast surgery.
A retrospective analysis of six selected patients undergoing mastectomy was performed. A mixture composed of 150mg ropivacaine, 400mg of lidocaine and 0.5mg epinephrine diluted in 500ml Ringer's were administered subcutaneously as follows: 80ml along the parasternal line from the second to the sixth intercostal space, 80ml along the mid axillary line from the second to the sixth intercostal space, 80ml along the infraclavicular line, 80ml in the space between the pectoralis muscle and the mammary gland and 80ml in the axilla in case of axillary dissection.
This technique achieved effective analgesia in six patients associated with sedation or light anaesthesia; conversion to general anaesthesia or supplementation with local anaesthesia was not required. No complication was observed. No emesis was noted.
This technique provides adequate peroperative analgesia and is a technically low-risk procedure. Further evaluation of this technique is recommended.
评估在大型乳房手术中锁骨上神经以及肋间神经前支和外侧支肿胀浸润的安全性和有效性。
对六例接受乳房切除术的选定患者进行回顾性分析。将150毫克罗哌卡因、400毫克利多卡因和0.5毫克肾上腺素混合于500毫升林格氏液中，按以下方式皮下给药：沿胸骨旁线从第二至第六肋间间隙注射80毫升，沿腋中线从第二至第六肋间间隙注射80毫升，沿锁骨下线注射80毫升，在胸大肌和乳腺之间的间隙注射80毫升，若进行腋窝清扫则在腋窝注射80毫升。
该技术在六例患者中实现了有效的镇痛，并伴有镇静或轻度麻醉；无需转为全身麻醉或补充局部麻醉。未观察到并发症。未出现呕吐。
该技术提供了充分的术中镇痛，且是一项技术风险较低的操作。建议对该技术进行进一步评估。
