Belzarena Sérgio D
Serviço de Anestesiologia da Santa Casa de Misericórdia de Santana do Livramento, RS.
Rev Bras Anestesiol. 2008 Nov-Dec;58(6):561-8. doi: 10.1590/s0034-70942008000600001.
Thoracic epidural block is frequently used for esthetic breast surgeries but reports of its use in mastectomies with axillary exploration are very rare. The present study compared this technique with general anesthesia in oncologic surgeries of the breasts.
Forty patients were divided in two groups. The epidural group (n = 20) underwent epidural thoracic block with bupivacaine and fentanyl associated with sedation with midazolam. The other group (n = 20) underwent conventional general anesthesia with propofol, atracurium, and fentanyl, and maintenance with O2 and isoflurane. Duration of the surgery, the need for intraoperative complementation of anesthesia or sedation, and intraoperative hemodynamic parameters were recorded. In the postoperative period, length of time until discharge from the recovery room and from the hospital, severity of pain, analgesic consumption, adverse effects, and satisfaction with the anesthetic techniques were recorded.
Both groups were similar and differences in the duration of the surgery were not observed. Complementary sedation was necessary in 100% of the patients who underwent epidural block and complementary sedation with infiltration of local anesthetic in the axilla in 15% of the patients in this group. The rate of hypertension was more frequent in the group of patients who underwent general anesthesia, while hypotension was more frequent in the epidural group. Pruritus was observed in 55% of the patients in the epidural group. Nausea (30%) and vomiting (45%) were more frequent in the general anesthesia group. The quality of postoperative analgesia was better in the epidural group, which also presented lower consumption of analgesics; the length hospitalization in this group was also lower.
Epidural block has some advantages when compared with general anesthesia and can be considered an anesthesia option in oncologic mastectomies with axillary lymph node dissection.
胸段硬膜外阻滞常用于美容性乳房手术，但关于其在腋窝探查的乳房切除术中应用的报道非常罕见。本研究比较了该技术与全身麻醉在乳房肿瘤手术中的效果。
40例患者分为两组。硬膜外组（n = 20）接受布比卡因和芬太尼的胸段硬膜外阻滞，并联合咪达唑仑镇静。另一组（n = 20）接受丙泊酚、阿曲库铵和芬太尼的传统全身麻醉，并以氧气和异氟烷维持麻醉。记录手术时间、术中麻醉或镇静补充的需求以及术中血流动力学参数。在术后阶段，记录从恢复室出院和从医院出院的时间长度、疼痛严重程度、镇痛药物消耗、不良反应以及对麻醉技术的满意度。
两组情况相似，未观察到手术时间的差异。接受硬膜外阻滞的患者中有100%需要补充镇静，该组中有15%的患者在腋窝局部麻醉浸润时需要补充镇静。全身麻醉组患者高血压发生率更高，而硬膜外组低血压更常见。硬膜外组55%的患者出现瘙痒。全身麻醉组恶心（30%）和呕吐（45%）更为常见。硬膜外组术后镇痛质量更好，镇痛药物消耗也更低；该组住院时间也更短。
与全身麻醉相比，硬膜外阻滞具有一些优势，可被视为腋窝淋巴结清扫的乳房肿瘤切除术中的一种麻醉选择。
