Pacik Peter T, Nelson Craig E, Werner Catherine
Aesthet Surg J. 2008 May-Jun;28(3):279-84. doi: 10.1016/j.asj.2008.02.001.
In an effort to give patients an additional effective form of analgesia, indwelling catheters for the instillation of a long-acting local anesthetic have been used to alleviate postoperative pain in patients undergoing augmentation mammaplasty.
This prospective study analyzes the safety and efficacy of this form of pain control in a consecutive series of 644 patients.
Patients were given a choice of intermittent bolus or continuous flow catheters for pain control. Prior to discharge, 20 mL of 0.25% bupivicaine with 1:400,000 epinephrine was instilled by a nurse into catheters for those patients receiving bolus self-administration. Pain scores for each side were recorded both before and 30 minutes after instillation. Patients then instilled 1 to 2 additional doses of bupivicaine during the first 24 hours and continued to record pain scores in the evening and following morning. For patients using continuous flow catheters, 0.25% bupivicaine without epinephrine was used to fill pumps that allowed up to 2 days of continuous flow at a rate of 2 mL per hour per side. Patients recorded pain at time intervals similar to those of patients using bolus self-administration. Questionnaires were given to all patients to determine the extent of pain reduction following the instillation of local anesthesia. More than 200 complete questionnaires were gathered, and pain scores from each of these were analyzed to gauge the efficacy of the instillation regimen.
Eighty-nine percent of the patients who self-administered a bolus of bupivacaine reported pain reduction on the evening of surgery, and 78% reported a reduction on the following morning, before implant mobility exercises. Catheters were maintained for 1 day postoperatively by 544 patients (84%) and for 2 days by 100 patients (16%). One patient developed an infection of unknown etiology that ultimately resulted in the loss of a unilateral implant.
A prospective study of 644 consecutive augmentation mammaplasty patients shows that indwelling catheters for the postoperative instillation of bupivacaine are both safe and effective in the management of postoperative pain. This gives the patient an additional form of analgesia, limited to the operative site, which is helpful in a multimodal pain management program. Both continuous flow and intermittent bolus self-administration systems are effective and their patient ratings are indistinguishable.
为了给患者提供另一种有效的镇痛方式，已使用留置导管注入长效局部麻醉剂来减轻接受隆乳术患者的术后疼痛。
这项前瞻性研究分析了连续644例患者采用这种疼痛控制方式的安全性和有效性。
患者可选择间歇性推注或持续输注导管来控制疼痛。出院前，对于接受推注自我给药的患者，护士将20毫升含1:400,000肾上腺素的0.25%布比卡因注入导管。记录每侧在注入前及注入后30分钟的疼痛评分。患者在术后24小时内再自行注入1至2剂布比卡因，并继续记录当晚及次日早晨的疼痛评分。对于使用持续输注导管的患者，使用不含肾上腺素的0.25%布比卡因填充泵，每侧以每小时2毫升的速度持续输注长达2天。患者按照与推注自我给药患者相似的时间间隔记录疼痛情况。向所有患者发放问卷，以确定局部麻醉剂注入后疼痛减轻的程度。收集了200多份完整问卷，并对每份问卷的疼痛评分进行分析，以评估注入方案的疗效。
自行推注布比卡因的患者中，89%报告在手术当晚疼痛减轻，78%报告在次日早晨植入物活动锻炼前疼痛减轻。544例患者（84%）术后保留导管1天，100例患者（16%）保留2天。1例患者发生病因不明的感染，最终导致单侧植入物丢失。
对644例连续隆乳术患者的前瞻性研究表明，术后注入布比卡因的留置导管在管理术后疼痛方面既安全又有效。这为患者提供了一种仅限于手术部位的额外镇痛方式，有助于多模式疼痛管理方案。持续输注和间歇性推注自我给药系统均有效，患者评分无差异。
