Bonde Christian, Khorasani Hoda, Hoejvig Jens, Kehlet Henrik
Department of Plastic Surgery, Breast Surgery and Burns, Section 2102, Copenhagen, Denmark.
Department of Plastic Surgery, Breast Surgery and Burns, Section 2102, Copenhagen, Denmark.
J Plast Reconstr Aesthet Surg. 2017 Nov;70(11):1543-1546. doi: 10.1016/j.bjps.2017.06.007. Epub 2017 Jun 20.
A key component of modern analgesics is the use of multimodal opioid-sparing analgesia (MOSA). In the past, our analgesic regime after autologous breast reconstruction (ABR) included either NSAID or a selective cyclooxygenase-2 (COX-2) inhibitor. COX-2 inhibitors are superior to NSAIDs because of the well-known side effects of NSAID treatment (bleeding/gastrointestinal ulcers). However, COX-2 inhibitors have been suggested to increase flap failure rates. We report our experience in using COX-2 inhibitors as part of our post-operative MOSA after ABR using free flaps.
A total of 132 unilateral secondary ABR were performed (DIEP or MS-TRAM) in the NSAID period (2007-2011) and 128 in the COX-2 inhibitor period (2006, 2012-2014). The same surgical team operated all patients. Data were collected prospectively and reviewed to compare the two periods, with special focus on reoperations due to bleeding/haematomas and flap thrombosis/failure. Comparisons between the COX-2 inhibitor and NSAID were made.
Median age, ischaemia time, blood loss and operating time were similar in the two periods. Significantly, more patients were re-operated because of post-operative haematoma in the NSAID group (n = 13/132, 9.8%) than in the COX-2 inhibitor group (n = 4/128, 3.1%) (p = 0.02). We found no difference in flap loss rates between the NSAID (n = 2/132, 1.5%) and the COX-2 inhibitor groups (n = 3/128, 2.3%) (p = 0.63). No patients suffered from thromboembolic complications or gastrointestinal bleeding.
Multimodal analgesia using a COX-2 inhibitor is safe in ABR with free flaps and does not increase flap failure. COX-2 inhibitors seem superior to NSAID with reduced risk of post-operative haematomas.
现代镇痛药物的一个关键组成部分是使用多模式阿片类药物节省镇痛（MOSA）。过去，我们在自体乳房重建（ABR）后的镇痛方案包括非甾体抗炎药（NSAID）或选择性环氧化酶-2（COX-2）抑制剂。由于NSAID治疗存在众所周知的副作用（出血/胃肠道溃疡），COX-2抑制剂优于NSAIDs。然而，有人提出COX-2抑制剂会增加皮瓣坏死率。我们报告了我们在使用COX-2抑制剂作为游离皮瓣ABR术后MOSA一部分的经验。
在NSAID时期（2007 - 2011年）共进行了132例单侧二期ABR（腹壁下动脉穿支皮瓣或肌肉下血管蒂横行腹直肌肌皮瓣），在COX-2抑制剂时期（2006年，2012 - 2014年）进行了128例。所有患者均由同一手术团队操作。前瞻性收集数据并进行回顾以比较两个时期，特别关注因出血/血肿和皮瓣血栓形成/坏死而进行的再次手术。对COX-2抑制剂组和NSAID组进行了比较。
两个时期的中位年龄、缺血时间、失血量和手术时间相似。值得注意的是，NSAID组因术后血肿而再次手术的患者（n = 13/132，9.8%）明显多于COX-2抑制剂组（n = 4/128，3.1%）（p = 0.02）。我们发现NSAID组（n = 2/132，1.5%）和COX-2抑制剂组（n = 3/128，2.3%）的皮瓣坏死率没有差异（p = 0.63）。没有患者发生血栓栓塞并发症或胃肠道出血。
在游离皮瓣ABR中使用COX-2抑制剂进行多模式镇痛是安全的，且不会增加皮瓣坏死率。COX-2抑制剂似乎优于NSAIDs，术后血肿风险降低。
