Pacik Peter T, Nelson Craig E, Werner Catherine
Aesthet Surg J. 2008 Nov-Dec;28(6):631-41. doi: 10.1016/j.asj.2008.09.001.
Postoperative pain following augmentation mammaplasty can cause significant disability. In the authors' previously published prospective study of 644 consecutive augmentation mammaplasty patients, it was shown that the use of indwelling catheters for the postoperative instillation of bupivacaine is both safe and effective in postoperative pain management.
This study analyzes a large population of augmentation mammaplasty patients to not only compare the effectiveness of catheter control with systemic analgesics but also to delineate sites of pain and determine if any of a variety of factors influence postoperative pain.
Questionnaires were given to all patients to record the extent of pain reduction following the instillation of local anesthesia, patient preference for a variety of analgesics, and the locations of postoperative pain. Potential correlations to pain-including the number of children, age, handedness, preoperative fear, pain tolerance, and length of narcotic use-were investigated using statistical analysis. Operative aspects, such as the size of implants, use of asymmetrical implants, intraoperative expansion, duration of surgery, and sharp versus blunt dissection were also studied to determine if these factors influenced postoperative pain.
Self-administration of bupivacaine the evening after surgery achieved pain reduction in 89% of patients. Patients gave high preference scores for the instillation of local anesthesia, comparable to rates achieved with the systemic narcotics Vicodin (Abbott Laboratories, Abbott Park, IL) and Percocet (Endo Pharmaceuticals, Chadds Ford, PA). Lower patient ratings were given to ibuprofen and methocarbamol. Patients identified multiple sites of postoperative pain, including the sternum, armpits, outer ribs, top of the breast (infraclavicular), interscapular region, and shoulders. Older patients experienced less pain. Patients who reported more pain, higher levels of fear, and sternal pain used narcotics for a longer period of time. Duration of surgery, blunt versus sharp dissection, and intraoperative expansion were not significantly related to pain. Combined implant size did not correlate with pain, though in the case of asymmetrical implants, greater pain (not statistically significant) on the larger side was reported.
Postoperative pain following augmentation mammaplasty may be influenced by several factors, but these appear unrelated to implant size, specific operative techniques (blunt versus sharp dissection), or duration of surgery. Pain may involve not only the breasts, but also the sternum, sides of the chest, armpits, and infraclavicular and interscapular areas. The use of indwelling catheters for the instillation of a long-acting anesthetic is rated comparable in efficacy to the systemic narcotics Vicodin and Percocet. Sternal pain can be severe and may require narcotics for effective pain control.
隆乳术后疼痛可导致严重功能障碍。在作者之前发表的一项对644例连续隆乳患者的前瞻性研究中，结果显示使用留置导管术后滴注布比卡因在术后疼痛管理中既安全又有效。
本研究分析大量隆乳患者，不仅比较导管控制与全身镇痛药的有效性，还要明确疼痛部位，并确定多种因素中是否有任何因素会影响术后疼痛。
向所有患者发放问卷，记录局部麻醉药滴注后疼痛减轻的程度、患者对多种镇痛药的偏好以及术后疼痛的部位。使用统计分析研究与疼痛的潜在相关性，包括子女数量、年龄、利手、术前恐惧、疼痛耐受性和使用麻醉药的时长。还研究了手术相关因素，如植入物大小、不对称植入物的使用、术中扩张、手术时长以及锐性与钝性分离，以确定这些因素是否会影响术后疼痛。
术后当晚自行滴注布比卡因使89%的患者疼痛减轻。患者对局部麻醉药滴注的偏好评分很高，与全身麻醉药维柯丁（雅培公司，伊利诺伊州雅培公园）和 Percocet（Endo制药公司，宾夕法尼亚州查兹福德）的评分相当。布洛芬和美索巴莫的患者评分较低。患者确定了多个术后疼痛部位，包括胸骨、腋窝、外侧肋骨、乳房顶部（锁骨下）、肩胛间区和肩部。年龄较大的患者疼痛较轻。报告疼痛较多、恐惧程度较高和胸骨疼痛的患者使用麻醉药的时间较长。手术时长、钝性与锐性分离以及术中扩张与疼痛无显著相关性。联合植入物大小与疼痛无相关性，不过对于不对称植入物，较大一侧报告的疼痛更严重（无统计学意义）。
隆乳术后疼痛可能受多种因素影响，但这些因素似乎与植入物大小、特定手术技术（钝性与锐性分离）或手术时长无关。疼痛可能不仅涉及乳房，还包括胸骨、胸部两侧、腋窝以及锁骨下和肩胛间区域。使用留置导管滴注长效麻醉药的疗效与全身麻醉药维柯丁和 Percocet相当。胸骨疼痛可能很严重，可能需要使用麻醉药来有效控制疼痛。
