Mazouz Dorval S, Salleron J, Guenane Y, Nguyen Van Nuoi V, Ozil C, Revol M, Sorin T
Service de chirurgie plastique reconstructrice et esthétique, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France; Paris Diderot University, Sorbonne Paris Cité, 75013 Paris, France.
Biostatistics department, Lorraine Cancer Institute - Alexis Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France.
Ann Chir Plast Esthet. 2016 Apr;61(2):91-4. doi: 10.1016/j.anplas.2016.01.004. Epub 2016 Feb 19.
Bilateral reduction mammaplasty (BRM) is a common procedure in plastic surgery. Our study aims to determine whether single-shot infiltration with ropivacaine during surgery reduces postoperative pain and decreases analgesic consumption.
In a prospective and monocentric study, all women operated by a single senior plastic surgeon, for whom BRM had been performed were included. The same surgical technique was performed for all patients (a superior pedicle, wise-pattern BRM with a closed-suction drainage). During the first half first part of the study period, none of the patients received ropivacaine infiltration (control group) and during the second half, all the patients received this infiltration (ropivacaine group). Infiltration was performed with a 20 mL solution of ropivacaine per side. Analgesic consumption and pain intensity were recorded during hospitalization and following discharge.
Forty-nine patients were divided into two groups (29 in the ropivacaine group and 20 in the control group). The ropivacaine group had a significantly lower consumption than the control group on all analgesics (paracetamol, tramadol, nefopam and morphin) (P < 0.001). Pain measurement reflected significantly lower scores in the ropivacaine group, both at four hours and three days postoperatively (P < 0.001). This difference was no longer significant at day 7 postoperatively (P=0.147).
Single-shot ropivacaine infiltration during surgery reduces postoperative pain and decreases the analgesic consumption. With this peroperative infiltration, BRM can be performed with good pain control and moderate analgesic consumption, limiting side effects.
双侧乳房缩小术（BRM）是整形外科的常见手术。我们的研究旨在确定手术期间单次注射罗哌卡因是否能减轻术后疼痛并减少镇痛药的使用量。
在一项前瞻性单中心研究中，纳入了由同一位资深整形外科医生实施BRM手术的所有女性患者。所有患者均采用相同的手术技术（上蒂、智慧型BRM并采用闭式负压引流）。在研究期的前半部分，所有患者均未接受罗哌卡因浸润（对照组）；在研究期的后半部分，所有患者均接受了该浸润（罗哌卡因组）。每侧使用20 mL罗哌卡因溶液进行浸润。记录住院期间及出院后的镇痛药使用量和疼痛强度。
49例患者被分为两组（罗哌卡因组29例，对照组20例）。罗哌卡因组在所有镇痛药（对乙酰氨基酚、曲马多、奈福泮和吗啡）的使用量上均显著低于对照组（P < 0.001）。疼痛测量结果显示，罗哌卡因组在术后4小时和3天时的得分显著更低（P < 0.001）。术后第7天时，这种差异不再显著（P = 0.147）。
手术期间单次注射罗哌卡因可减轻术后疼痛并减少镇痛药的使用量。通过这种术中浸润，BRM手术可以实现良好的疼痛控制和适度的镇痛药使用量，同时限制副作用。
