不使用阿片类镇痛药的双侧乳房缩小术：一项对比研究。
Bilateral Breast Reduction Without Opioid Analgesics: A Comparative Study.
作者信息
Parsa Fereydoun Don, Cheng Justin, Stephan Brad, Castel Nikki, Kim Leslie, Murariu Daniel, Parsa Alan A
机构信息
Department of Surgery, Division of Plastic Surgery, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI. Department of Surgery, Division of Plastic Surgery, Rutgers New Jersey Medical School, Newark, NJ. Department of Plastic Surgery, University of Virginia Health System, Charlottesville, VA. Department of Medicine, University of Hawaii, John A Burns School of Medicine, Honolulu, HI.
出版信息
Aesthet Surg J. 2017 Sep 1;37(8):892-899. doi: 10.1093/asj/sjx038.
BACKGROUND
Breast reduction has traditionally been performed under general anesthesia with adjunct opioid use. However, opioids are associated with a wide variety of adverse effects, including nausea, vomiting, constipation, postoperative sedation, dizziness, and addiction.
OBJECTIVES
This study compares bilateral breast reduction using a multimodal opioid-free pain management regimen vs traditional general anesthesia with adjunct opioids.
METHODS
A total of 83 female patients were enrolled in this study. Group 1 includes a retrospective series of 39 patients that underwent breast reduction via general anesthesia with adjunct opioid use. This series was compared to 2 prospective groups of patients who did not receive opioids either preoperatively or intraoperatively. In group 2, twenty-six patients underwent surgery under intravenous sedation and local anesthesia. In group 3, eighteen patients underwent surgery with general anesthesia. All patients in groups 2 and 3 received preoperative gabapentin and celecoxib along with infiltration of local anesthetics during the operation and prior to discharge to the Post-Anesthesia Care Unit (PACU). Primary outcome measures included the duration of surgery, time from end of operation to discharge home, postoperative opioid and antiemetic use, and unplanned postoperative hospitalizations.
RESULTS
When compared to group 1, groups 2 and 3 experienced a shorter time from end of operation to discharge home (P < 0.05), fewer unplanned hospital admissions (P < 0.05), and highly significant decrease in postoperative opioid use (P < 0.001).
CONCLUSIONS
This multimodal approach allows patients to safely undergo opioid-free bilateral breast reduction either under local or general anesthesia as an outpatient. This method resulted in significantly less morbidity, use of opioids postoperatively, as well as unplanned hospital admissions compared to "traditional" breast reduction under general anesthesia with the use of opioids.
LEVEL OF EVIDENCE
背景
传统上，缩乳手术是在全身麻醉并辅助使用阿片类药物的情况下进行的。然而，阿片类药物会引发多种不良反应，包括恶心、呕吐、便秘、术后镇静、头晕和成瘾。
目的
本研究比较了采用多模式无阿片类药物疼痛管理方案进行双侧缩乳手术与采用传统全身麻醉并辅助使用阿片类药物的效果。
方法
本研究共纳入83例女性患者。第1组包括39例回顾性系列患者，这些患者通过全身麻醉并辅助使用阿片类药物进行了缩乳手术。该系列与另外2组前瞻性患者进行了比较，这2组患者在术前或术中均未使用阿片类药物。在第2组中，26例患者在静脉镇静和局部麻醉下接受了手术。在第3组中，18例患者接受了全身麻醉手术。第2组和第3组的所有患者在术前均接受了加巴喷丁和塞来昔布治疗，并在手术期间及出院前往麻醉后监护病房（PACU）之前接受了局部麻醉药浸润。主要观察指标包括手术时间、从手术结束到出院回家的时间、术后阿片类药物和止吐药的使用情况以及术后非计划住院情况。
结果
与第1组相比，第2组和第3组从手术结束到出院回家的时间更短（P < 0.05），非计划住院次数更少（P < 0.05），术后阿片类药物的使用量显著减少（P < 0.001）。
结论
这种多模式方法使患者能够在局部或全身麻醉下作为门诊患者安全地进行无阿片类药物的双侧缩乳手术。与使用阿片类药物的“传统”全身麻醉缩乳手术相比，该方法导致的发病率、术后阿片类药物使用量以及非计划住院次数均显著降低。
证据级别
3级。
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