Jabs Dean, Richards Bryson G, Richards Franklin D
University of Rochester, NY, USA.
Aesthet Surg J. 2008 Sep-Oct;28(5):528-33. doi: 10.1016/j.asj.2008.07.005.
In submuscular breast augmentation, the muscle is transected along its inferior and medial border to allow the implant to rest beneath the breast mound and supply adequate cleavage. This leads to significant pain in the postoperative period.
This study was undertaken to quantitatively document the effectiveness of tumescent infiltration and bupivicaine with epinephrine injection in controlling postoperative pain in primary submuscular breast augmentation and its effect on operating time, narcotic use, and complications.
A retrospective chart review of 150 primary submuscular augmentation mammaplasties performed by 2 surgeons was conducted. Seventy-five consecutive augmentations performed by each physician during the same time period were studied. One surgeon used tumescent infiltration, using a syringe and a blunt infiltration cannula, placing 50 mL of standard tumescent solution in the planned pocket area of each breast before dissection. In addition, all cut muscle ends were injected with 0.25% bupivicaine with epinephrine (1:100,000, 40 mL per patient) under direct vision. The other surgeon omitted these steps. Patients evaluated pain subjectively using a 0 to 10 numeric pain intensity scale reported to the recovery room staff at specific times in the postanesthesia care unit.
Postoperatively, the initial and discharge average pain rating was significantly different between the groups. The group that received tumescence and bupivicaine with epinephrine entered the recovery room with a significantly lower average pain score: 0.5 as compared with the pain score of the control group, which was on average 3.3. In addition, the highest average pain rating was 2.6 in the infiltrated group compared with 5.4 in the noninfiltrated group. Pain at discharge between the groups was also seen to be markedly lower with a subjective average rating of 2.0 in the infiltrated group compared with 4.0 in the control group. No difference was seen in operative time or complications.
This is the first report to quantitatively show a pain reduction regimen that is effective in significantly decreasing postoperative pain and decreasing the use of narcotics in the recovery room. The authors conclude that its advantages are significant, and they advocate its use in all breast augmentations.
在胸大肌下隆乳术中，需沿胸大肌下缘和内侧缘切断肌肉，以使植入物置于乳房下方并提供足够的乳沟。这会导致术后出现明显疼痛。
本研究旨在定量记录肿胀液浸润联合肾上腺素注射布比卡因在控制初次胸大肌下隆乳术后疼痛方面的有效性，及其对手术时间、麻醉药物使用和并发症的影响。
对两位外科医生实施的150例初次胸大肌下隆乳术进行回顾性病历分析。研究每位医生在同一时期连续进行的75例隆乳术。一位外科医生采用肿胀液浸润，使用注射器和钝头浸润套管，在切开前于每个乳房的计划腔隙区域注入50 mL标准肿胀液。此外，在直视下向所有切断的肌肉断端注射含肾上腺素的0.25%布比卡因（1:100,000，每位患者40 mL）。另一位外科医生省略了这些步骤。患者在麻醉后护理单元的特定时间，使用0至10数字疼痛强度量表向恢复室工作人员主观评估疼痛情况。
术后，两组患者的初始和出院时平均疼痛评分存在显著差异。接受肿胀液浸润联合肾上腺素注射布比卡因的组进入恢复室时的平均疼痛评分显著更低：为0.5，而对照组的疼痛评分为3.3。此外，浸润组的最高平均疼痛评分为2.6，而非浸润组为5.4。两组出院时的疼痛也明显较低，浸润组的主观平均评分为2.0，而对照组为4.0。手术时间或并发症方面未观察到差异。
这是第一份定量显示有效减轻术后疼痛并减少恢复室麻醉药物使用的镇痛方案的报告。作者得出结论，其优势显著，并提倡在所有隆乳术中使用。
