Tan Pamela, Martin Morgan Sparks, Shank Nina, Myers Leann, Wolfe Emily, Lindsey John, Metzinger Stephen
From the *Division of Plastic and Reconstructive Surgery, and †Department of Biostatistics and Bioinformatics, Tulane University, New Orleans, LA.
Ann Plast Surg. 2017 Jun;78(6S Suppl 5):S299-S304. doi: 10.1097/SAP.0000000000001132.
Patients undergoing breast augmentation are treated with multiple combinations of medications for pain control including ketorolac, liposomal bupivacaine, bupivacaine, and intravenous and oral narcotics. There is no current consensus on the optimal combination; therefore, all are used at the discretion of the surgeon.
This was a single-center, retrospective study. The total number of patients included was 132. Comparisons were made between 4 groups: bupivacaine only (B); bupivacaine and liposomal bupivacaine (BL); bupivacaine and liposomal bupivacaine plus intraoperative ketorolac (BLKi); and bupivacaine and liposomal bupivacaine plus postoperative ketorolac (BLKp). Average pain scores immediately postoperative and before discharge were recorded and correlated to percentage of patients who received narcotic in the post-anesthesia care unit (PACU). Additional end points noted were side effects including nausea and time spent in PACU postoperatively.
Those receiving intraoperative ketorolac had the lowest pain on discharge (P < 0.0001) and the lowest percentage of patients receiving narcotics (P = 0.009) out of all 4 groups. There was no significant difference between the 4 groups in terms of time spent in PACU, pain immediately after the procedure, or amount of antiemetic given. No bleeding complications were noted for those who did or did not receive ketorolac.
When given options for pain control in breast augmentation, intraoperative ketorolac should be considered, because its inclusion was significant in decreasing use of narcotics and pain upon discharge. Addition of other costly drugs such as liposomal bupivacaine may not provide additional benefit in the immediate postoperative setting for procedures with a short recovery period such as breast augmentation.
接受隆胸手术的患者会使用多种药物组合来控制疼痛，包括酮咯酸、脂质体布比卡因、布比卡因以及静脉和口服麻醉药。目前对于最佳组合尚无共识；因此，所有药物均由外科医生酌情使用。
这是一项单中心回顾性研究。纳入的患者总数为132例。对四组进行了比较：仅使用布比卡因组（B）；布比卡因和脂质体布比卡因组（BL）；布比卡因和脂质体布比卡因加术中使用酮咯酸组（BLKi）；布比卡因和脂质体布比卡因加术后使用酮咯酸组（BLKp）。记录术后即刻和出院前的平均疼痛评分，并与在麻醉后护理单元（PACU）接受麻醉药的患者百分比相关联。记录的其他终点包括副作用，如恶心以及术后在PACU的停留时间。
在所有四组中，术中使用酮咯酸的患者出院时疼痛最低（P < 0.0001），接受麻醉药的患者百分比最低（P = 0.009）。四组在PACU的停留时间、手术后即刻疼痛或使用止吐药的量方面无显著差异。接受或未接受酮咯酸的患者均未出现出血并发症。
在隆胸手术的疼痛控制选择中，应考虑术中使用酮咯酸，因为它在减少麻醉药使用和出院时疼痛方面具有显著作用。对于隆胸等恢复期短的手术，在术后即刻添加脂质体布比卡因等其他昂贵药物可能不会带来额外益处。
