Versyck Barbara, van Geffen Geert-Jan, Van Houwe Patrick
GZA Sint-Augustinus, Oosterveldlaan 24, 2610 Wilrijk, Belgium.
Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
J Clin Anesth. 2017 Aug;40:46-50. doi: 10.1016/j.jclinane.2017.03.054. Epub 2017 Apr 19.
The aim of this clinical trial was to test the hypothesis whether adding the pectoral nerves (Pecs) block type II to the anesthetic procedure reduces opioid consumption during and after breast surgery.
A prospective randomized double blind placebo-controlled study.
A secondary hospital.
140 breast cancer stage 1-3 patients undergoing mastectomy or tumorectomy with sentinel node or axillary node dissection.
Patients were randomized to receive either a Pecs block with levobupivacaine 0.25% (n=70) or placebo block with saline (n=70).
The pain levels were evaluated by Numeric Rating Scale (NRS) pain scores at 15-minute intervals during the post anesthesia care unit stay time (PACU), at 2-hour intervals for the first 24h on the ward and at 4-hour intervals for the next 24h. Intraoperative and postoperative opioid consumption were recorded during the full stay. Patient satisfaction was evaluated upon discharge using a 10-point scale.
Intraoperative sufentanil requirements were comparable for the Pecs and placebo group (8.0±3.5μg and 7.8±3.0μg, P=0.730). Patients in the Pecs group experienced significantly less pain than patients in the control group (P=0.048) during their PACU stay. Furthermore, patients in the Pecs group required significant less postoperative opioids (9.16±10.15mg and 14.97±14.38mg morphine equivalent, P=0.037) and required significant fewer postsurgical opioid administration interventions than patients in the control group (P=0.045). Both patient-groups were very satisfied about their management (9.6±0.6 and 9.1±1.8 on a 10-point scale, P=0.211).
The Pecs block reduces postsurgical opioid consumption during the PACU stay time for patients undergoing breast surgery.
本临床试验的目的是检验在麻醉过程中添加Ⅱ型胸肌神经（Pecs）阻滞是否能减少乳腺手术后及术后的阿片类药物用量这一假设。
一项前瞻性随机双盲安慰剂对照研究。
一家二级医院。
140例1 - 3期乳腺癌患者，接受乳房切除术或肿瘤切除术并进行前哨淋巴结或腋窝淋巴结清扫。
患者被随机分为两组，一组接受0.25%左旋布比卡因的Pecs阻滞（n = 70），另一组接受生理盐水的安慰剂阻滞（n = 70）。
在麻醉后护理单元（PACU）停留期间，每隔15分钟通过数字评分量表（NRS）疼痛评分评估疼痛程度；在病房的前24小时每隔2小时评估一次，接下来的24小时每隔4小时评估一次。记录整个住院期间术中及术后的阿片类药物用量。出院时使用10分制评估患者满意度。
Pecs组和安慰剂组术中舒芬太尼需求量相当（8.0±3.5μg和7.8±3.0μg，P = 0.730）。Pecs组患者在PACU停留期间的疼痛明显低于对照组（P = 0.048）。此外，Pecs组患者术后所需阿片类药物明显更少（吗啡当量为9.16±10.15mg和14.97±14.38mg，P = 0.037），且术后阿片类药物给药干预次数明显少于对照组（P = 0.045）。两组患者对其治疗管理都非常满意（10分制下分别为9.6±0.6和9.1±1.8，P = 0.211）。
Pecs阻滞可减少乳腺手术患者在PACU停留期间的术后阿片类药物用量。
