Division of Plastic and Reconstructive Surgery, McGill University Health Center, Department of Anesthesia, Faculty of Medicine, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada.
J Plast Reconstr Aesthet Surg. 2011 Oct;64(10):1261-9. doi: 10.1016/j.bjps.2011.03.025. Epub 2011 Apr 12.
Thoracic paravertebral block (TPVB) offers an attractive alternative to general anaesthesia (GA) for ambulatory breast surgery. The aim of this meta-analysis was first to evaluate the safety and efficacy of TPVB for breast surgery, and second to compare TPVB with GA with regard to postoperative pain, nausea and vomiting, opioid consumption and length of hospital stay.
An electronic and manual search of English- and French-language articles on TPVB in breast surgery (published from January 1980 to June 2010) yielded 41 citations. Two levels of screening identified 11 relevant studies. The Mantel-Haenszel method (fixed effect) was used to perform the meta-analysis.
Eleven studies were retained for analysis. When TPVB was used instead of GA, pain scores were significantly decreased at 1 and 6 h postoperatively (mean difference of 2.48 (95%confidence interval (CI): 2.20-2.75) and 1.71 (95%CI: 1.64-1.78), respectively). Furthermore, postoperative analgesic consumption was significantly lower in patients who received TPVB compared with GA (relative risk (RR) 0.23, (95%CI: 0.15-0.37)). TPVB was also associated with significantly less postoperative nausea and vomiting (RR 0.27 (95%CI: 0.12-0.61)). Increased patient satisfaction and a shorter hospital stay also favoured TPVB over GA.
TPVB provides effective anaesthesia for ambulatory breast surgery and can result in significant benefits over GA. However, further studies are required to determine whether these advantages would still be present if an optimal technique for outpatient GA is employed. Adjunctive ultrasonography may contribute to improve the safety of TPVB in breast surgery and requires further investigation.
胸椎旁神经阻滞（TPVB）为日间乳房手术提供了一种有吸引力的全身麻醉（GA）替代方案。本荟萃分析的目的首先是评估 TPVB 在乳房手术中的安全性和有效性，其次是比较 TPVB 与 GA 在术后疼痛、恶心和呕吐、阿片类药物消耗和住院时间方面的差异。
通过电子和手动检索从 1980 年 1 月至 2010 年 6 月发表的关于乳房手术中 TPVB 的英语和法语文章，共获得 41 篇引文。通过两级筛选确定了 11 项相关研究。采用 Mantel-Haenszel 方法（固定效应）进行荟萃分析。
共保留 11 项研究进行分析。当使用 TPVB 替代 GA 时，术后 1 小时和 6 小时的疼痛评分显著降低（平均差值分别为 2.48（95%置信区间（CI）：2.20-2.75）和 1.71（95%CI：1.64-1.78））。此外，与 GA 相比，接受 TPVB 的患者术后镇痛药物消耗明显减少（相对风险（RR）0.23（95%CI：0.15-0.37））。TPVB 还与术后恶心和呕吐的发生率显著降低相关（RR 0.27（95%CI：0.12-0.61））。患者满意度增加和住院时间缩短也使 TPVB 优于 GA。
TPVB 为日间乳房手术提供了有效的麻醉，并且与 GA 相比可能具有显著的优势。然而，如果采用最佳的门诊 GA 技术，仍需要进一步的研究来确定这些优势是否仍然存在。辅助超声可能有助于提高乳房手术中 TPVB 的安全性，需要进一步研究。
