Department of Anaesthesia, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
Department of Breast Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
Anaesthesia. 2018 Apr;73(4):438-443. doi: 10.1111/anae.14213. Epub 2018 Jan 12.
Avoidance of general anaesthesia for breast surgery may be because of clinical reasons or patient choice. There is emerging evidence that the use of regional anaesthesia and the avoidance of volatile anaesthetics and opioid analgesia may have beneficial effects on oncological outcomes. We conducted a prospective observational case series of 16 breast cancer surgeries performed under thoracic paravertebral plus pectoral nerve block with propofol sedation to demonstrate feasibility of technique, patient acceptability and surgeon satisfaction. Fifteen out of 16 cases were successfully completed under sedation and regional anaesthesia, with one conversion to general anaesthesia. Eleven out of 16 cases required low-dose intra-operative opioid analgesia. Out of the 15 surgical procedures completed under regional anaesthesia with sedation, all patients experienced either no or minimal intra-operative pain, and all would choose this anaesthetic technique again. Surgeon-reported operating conditions were 'indistinguishable from general anaesthesia' in most cases, and surgeons were 'extremely satisfied' or 'satisfied' with the technique after every procedure. Combined thoracic paravertebral plus pectoral nerve block with intra-operative sedation is a feasible technique for breast surgery.
避免全身麻醉用于乳房手术可能是因为临床原因或患者选择。有新的证据表明，使用区域麻醉和避免挥发性麻醉剂和阿片类镇痛药可能对肿瘤学结果有有益的影响。我们进行了一项前瞻性观察性病例系列研究，共 16 例乳腺癌手术在胸椎旁加胸肌神经阻滞下进行，使用异丙酚镇静来证明该技术的可行性、患者的可接受性和外科医生的满意度。16 例中有 15 例在镇静和区域麻醉下成功完成，其中 1 例转为全身麻醉。16 例中有 11 例需要低剂量术中阿片类药物镇痛。在镇静下完成的 15 例区域麻醉手术中，所有患者均经历了无或轻微的术中疼痛，并且所有患者都愿意再次选择这种麻醉技术。大多数情况下，外科医生报告的手术条件“与全身麻醉无法区分”，并且每位外科医生在每次手术后都对该技术“非常满意”或“满意”。联合胸椎旁加胸肌神经阻滞和术中镇静是乳房手术的一种可行技术。
