Wolf Omer, Clemens Mark W, Purugganan Ronaldo V, Crosby Melissa A, Kowalski Alicia M, Kee Spencer S, Liu Jun, Goravanchi Farzin
Houston, Texas.
From the Departments of Plastic Surgery and Anesthesia, The University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2016 Apr;137(4):660e-666e. doi: 10.1097/01.prs.0000481070.79186.0d.
Paravertebral blocks have gained popularity because of ease of implementation and a shift toward ambulatory breast surgery procedures. Previous retrospective studies have reported potential benefits of paravertebral blocks, including decreased narcotic and antiemetic use.
The authors conducted a prospective controlled trial of patients undergoing breast reconstruction over a 3-year period. The patients were randomized to either a study group of paravertebral blocks with general anesthesia or a control group of general anesthesia alone. Demographic and procedural data, in addition to data regarding pain and nausea patient-reported numeric scores and consumption of opioid and antiemetic medications, were recorded.
A total of 74 patients were enrolled to either the paravertebral block (n = 35) or the control group (n = 39). There were no significant differences in age, body mass index, procedure type, or cancer diagnosis between the two groups. Patients who received a paravertebral block required less opioid intraoperatively and postoperatively combined compared with patients who did not receive paravertebral blocks (109 versus 246 fentanyl equivalent units; p < 0.001), and reported significantly lower pain scores at 0 to 1 (3.0 versus 4.6; p = 0.02), 1 to 3 (2.0 versus 3.2; p = 0.01), and 3 to 6 (1.9 versus 2.7; p = 0.04) hours postoperatively. The study group also consumed less antiemetic medication (0.7 versus 2.1; p = 0.05).
Incorporating paravertebral blocks carries considerable potential for improving pathways for breast cancer patients undergoing breast reconstruction--with minimal procedure-related morbidity. This is the first prospective study designed to assess paravertebral blocks in the setting of prosthetic breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
椎旁阻滞因其实施简便以及门诊乳房手术的发展趋势而越来越受欢迎。既往回顾性研究报道了椎旁阻滞的潜在益处，包括减少麻醉药和止吐药的使用。
作者对3年内接受乳房重建的患者进行了一项前瞻性对照试验。患者被随机分为椎旁阻滞联合全身麻醉的研究组或单纯全身麻醉的对照组。记录人口统计学和手术数据，以及患者报告的疼痛和恶心数字评分、阿片类药物和止吐药物使用情况的数据。
共有74例患者纳入椎旁阻滞组（n = 35）或对照组（n = 39）。两组在年龄、体重指数、手术类型或癌症诊断方面无显著差异。与未接受椎旁阻滞的患者相比，接受椎旁阻滞的患者术中及术后联合使用的阿片类药物更少（109与246芬太尼当量单位；p < 0.001），且术后0至1小时（3.0与4.6；p = 0.02）、1至3小时（2.0与3.2；p = 0.01）和3至6小时（1.9与2.7；p = 0.04）的疼痛评分显著更低。研究组使用的止吐药物也更少（0.7与2.1；p = 0.05）。
在接受乳房重建的乳腺癌患者中采用椎旁阻滞有很大潜力改善治疗途径，且手术相关的发病率极低。这是第一项旨在评估假体乳房重建中椎旁阻滞的前瞻性研究。
临床问题/证据水平：治疗性，II级
