Fajardo-Pérez Mario, Altınpulluk Ece Yamak, García-Miguel Javier, Quintana-Gordon Borja
Department of Anesthesiology, Móstoles University Hospital, Madrid, Spain.
Department of Anesthesiology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.
Turk J Anaesthesiol Reanim. 2017 Apr;45(2):112-115. doi: 10.5152/TJAR.2017.43815. Epub 2017 Apr 1.
Using a single dose of local anaesthetics has some disadvantages and provides limited analgesia depending on the pharmacokinetic characteristics of the local anaesthetic used. Nevertheless, the use of continuous perineural infusions allows sustained pain control. Ultrasound-guided interpectoral block followed by the placement of catheters in patients undergoing mastectomies with or without lymph node axillary dissections can result in sufficient pain control. We present a case of a 58-year-old woman undergoing mastectomy and axillary clearance who received ultrasound-guided continuous interpectoral block for postoperative analgesia. After the induction of general anaesthesia, interpectoral ultrasound block was performed and levobupivacaine was administered through a catheter placed between the pectoralis minor and pectoralis major muscles using an ultrasound-guided technique. We used an elastomeric pump containing the 0.125% levobupivacaine anaesthetic solution, with an infusion rate of 5 mL h for 48 h. Excellent postoperative pain control was observed. Local anaesthetic- and catheter-related side-effects were not observed. The ideal infusion rate for interpectoral block in patients under mastectomy has not been determined. More randomised studies are needed to confirm whether interpectoral techniques are appropriate for routine clinical practice.
使用单剂量局部麻醉药存在一些缺点，并且根据所用局部麻醉药的药代动力学特性，其镇痛效果有限。然而，连续神经周围输注可实现持续的疼痛控制。在接受或未接受腋窝淋巴结清扫术的乳房切除术患者中，超声引导下胸肌间阻滞并随后放置导管可实现充分的疼痛控制。我们报告一例58岁接受乳房切除术和腋窝清扫术的女性患者，其接受了超声引导下连续胸肌间阻滞用于术后镇痛。全身麻醉诱导后，进行胸肌间超声阻滞，并使用超声引导技术通过置于胸小肌和胸大肌之间的导管给予左旋布比卡因。我们使用了一个装有0.125%左旋布比卡因麻醉溶液的弹性泵，输注速率为5 mL/h，持续48小时。观察到术后疼痛控制良好。未观察到与局部麻醉药和导管相关的副作用。乳房切除术患者胸肌间阻滞的理想输注速率尚未确定。需要更多的随机研究来确认胸肌间技术是否适用于常规临床实践。
