Abdallah Faraj W, MacLean David, Madjdpour Caveh, Cil Tulin, Bhatia Anuj, Brull Richard
From the *Department of Anesthesia, University of Toronto, Ontario, Canada; †Department of Anesthesia and Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; ‡Department of Anesthesia, Women's College Hospital, Toronto, Ontario, Canada; §Department of Surgery, University of Toronto, Ontario, Canada; and ‖Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada.
Anesth Analg. 2017 Jul;125(1):294-302. doi: 10.1213/ANE.0000000000001975.
Pectoralis and serratus blocks have been described recently for use in breast surgery, but evidence supporting their analgesic benefits is limited. This cohort study evaluates the benefits of adding a pectoralis or serratus block to conventional opioid-based analgesia (control) in patients who underwent ambulatory breast cancer surgery at Women's College Hospital between July 2013 and May 2015. We tested the joint hypothesis that adding a pectoralis or serratus block reduced postoperative in-hospital (predischarge) opioid consumption and nausea and vomiting (PONV). We also examined the 2 block types for noninferiority.
A total of 225 patients were propensity matched on 5 potential confounders among 3 study groups (75 per group): (1) pectoralis; (2) serratus; and (3) control. The propensity-matched cohort was used to evaluate the effect of the study group on postoperative in-hospital oral morphine equivalent consumption and PONV. We considered pectoralis noninferior to serratus block if it was noninferior for both outcomes, within 10 mg morphine and 17.5% in PONV incidence margins. Other outcomes included intraoperative fentanyl requirements, pain scores, time to first analgesic request, and duration of recovery room stay.
Both pectoralis and serratus blocks were each associated with reduced postoperative in-hospital opioid consumption and PONV compared with control. Pectoralis was noninferior to serratus block for these 2 outcomes. Pectoralis and serratus blocks were each associated with reduced intraoperative fentanyl requirements, prolonged time to first analgesic request, and expedited recovery room discharge compared with control; there were no differences for the remaining outcomes.
Pectoralis and serratus blocks were each associated with a reduction in postoperative in-hospital opioid consumption and PONV compared with conventional opioid-based analgesia after ambulatory breast cancer surgery.
胸肌阻滞和锯肌阻滞最近已被描述用于乳腺手术，但支持其镇痛效果的证据有限。这项队列研究评估了在2013年7月至2015年5月期间于女子学院医院接受门诊乳腺癌手术的患者中，在传统的基于阿片类药物的镇痛（对照组）基础上加用胸肌阻滞或锯肌阻滞的益处。我们检验了联合假设，即加用胸肌阻滞或锯肌阻滞可减少术后住院期间（出院前）的阿片类药物消耗量以及恶心和呕吐（PONV）。我们还比较了这两种阻滞类型的非劣效性。
在3个研究组（每组75例）之间，根据5个潜在混杂因素进行倾向评分匹配，共纳入225例患者：（1）胸肌阻滞组；（2）锯肌阻滞组；（3）对照组。倾向评分匹配队列用于评估研究组对术后住院期间口服吗啡当量消耗量和PONV的影响。如果胸肌阻滞组在两种结局方面均不劣于锯肌阻滞组，即吗啡消耗量不超过10 mg且PONV发生率不超过17.5%，则认为胸肌阻滞不劣于锯肌阻滞。其他结局包括术中芬太尼需求量、疼痛评分、首次要求镇痛的时间以及恢复室停留时间。
与对照组相比，胸肌阻滞和锯肌阻滞均与术后住院期间阿片类药物消耗量减少以及PONV减少相关。在这两种结局方面，胸肌阻滞不劣于锯肌阻滞。与对照组相比，胸肌阻滞和锯肌阻滞均与术中芬太尼需求量减少、首次要求镇痛的时间延长以及恢复室出院加快相关；其余结局方面无差异。
与门诊乳腺癌手术后传统的基于阿片类药物的镇痛相比，胸肌阻滞和锯肌阻滞均与术后住院期间阿片类药物消耗量减少以及PONV减少相关。
