Wang Kaiyuan, Zhang Xiaobei, Zhang Tingting, Yue Hui, Sun Shan, Zhao Hongwei, Zhou Peng
Department of Anesthesiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin.
Hospital of Jining Medical University, Jining, Shandong, China.
Clin J Pain. 2018 Mar;34(3):231-236. doi: 10.1097/AJP.0000000000000529.
The pectoral nerves (Pecs) II block is a technique that places local anesthetic between the thoracic muscles to block the axillary and breast regions. This study aimed to compare the quality of perioperative analgesia and side effects of the Pecs II block under general anesthesia versus general anesthesia alone in immediate unilateral breast reconstruction with an implant and latissimus dorsi flap after modified radical mastectomy.
Sixty-four patients scheduled for immediate breast reconstruction after modified radical mastectomy were randomly allocated into the Pecs II block under general anesthesia group (group P, n=32) or the general anesthesia alone group (group G, n=32). After anesthesia induction, patients in group P underwent a Pecs II block. The primary endpoint was postoperative morphine consumption in the first 24 hours in postoperative intensive care unit. Intraoperative fentanyl consumption, visual analog scale scores, shoulder range of motion, and postoperative nausea and vomiting were also assessed.
Sixty patients completed the study. There was a significant reduction in postoperative morphine consumption (3.67 mg; 95% confidence interval, 2.91-4.51 mg) and intraoperative fentanyl consumption in group P patients compared with group G patients. Less postoperative nausea and vomiting (relative risk 0.22; 95% confidence interval, 0.05-0.94) and lower visual analog scale scores were also observed in group P. No block-related complications were recorded.
When patients underwent immediate breast reconstruction with an implant and latissimus dorsi flap, the Pecs II block offers a comprehensive block of associated nerves in the surgical area, and therefore can provide superior analgesia and reduced perioperative opioids use without obvious block-related complications.
胸肌神经（Pecs）Ⅱ阻滞是一种将局部麻醉药注入胸肌之间以阻滞腋窝和乳房区域的技术。本研究旨在比较全身麻醉联合PecsⅡ阻滞与单纯全身麻醉用于改良根治性乳房切除术后即刻单侧乳房植入物和背阔肌肌皮瓣重建时的围手术期镇痛质量及副作用。
64例计划行改良根治性乳房切除术后即刻乳房重建的患者被随机分为全身麻醉联合PecsⅡ阻滞组（P组，n = 32）和单纯全身麻醉组（G组，n = 32）。麻醉诱导后，P组患者接受PecsⅡ阻滞。主要终点是术后重症监护病房第1个24小时内的吗啡消耗量。还评估了术中芬太尼消耗量、视觉模拟评分、肩关节活动范围以及术后恶心呕吐情况。
60例患者完成研究。与G组患者相比，P组患者术后吗啡消耗量（3.67 mg；95%置信区间，2.91 - 至4.51 mg）和术中芬太尼消耗量显著降低。P组术后恶心呕吐也较少（相对风险0.22；95%置信区间，0.05 - 0.94），视觉模拟评分也较低。未记录到与阻滞相关的并发症。
当患者接受乳房植入物和背阔肌肌皮瓣即刻乳房重建时，PecsⅡ阻滞可全面阻滞手术区域的相关神经，因此能提供更好的镇痛效果，减少围手术期阿片类药物的使用，且无明显的与阻滞相关的并发症。
