Tripathy Swagata, Rath Satyajit, Agrawal Suresh, Rao P Bhaskar, Panda A, Mishra T S, Nayak Sukdev
Department of Anesthesia and Intensive Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
J Anaesthesiol Clin Pharmacol. 2018 Jan-Mar;34(1):35-40. doi: 10.4103/joacp.JOACP_143_17.
Opioids are associated with postoperative nausea, vomiting, drowsiness, and increased analgesic requirement. A nonopioid anesthesia technique may reduce morbidity, enable day care surgery, and possibly decrease tumor recurrence. We compared opioid-free, nerve block-based anesthesia with opioid-based general anesthesia for breast cancer surgery in a prospective cohort study.
Twenty four adult American Society of Anesthesiologists grade I-III patients posted for modified radical mastectomy (MRM) with axillary dissection were induced with propofol and maintained on isoflurane (0.8-1.0 minimum alveolar concentration) through i-gel on spontaneous ventilation and administered ultrasound-guided PECS 1 and 2 blocks (0.1% lignocaine + 0.25% bupivacaine + 1 mcg/kg dexmedetomidine, 30 ml). Postoperative nausea, pain scores, nonopioid analgesic requirement over 24 h, stay in the recovery room, and satisfaction of surgeon and patient were studied. Twenty-four patients who underwent MRM and axillary dissection without a nerve block under routine opioid anesthesia with controlled ventilation were the controls.
MRM and axillary dissection under the nonopioid technique was adequate in all patients. Time in the recovery room, postoperative nausea, analgesic requirement, and visual analog scale scores were all significantly less in the nonopioid group. Surgeon and patient were satisfied with good patient quality of life on day 7.
Nonopioid nerve block technique is adequate and safe for MRM with axillary clearance. Compared to conventional technique, it offers lesser morbidity and may allow for earlier discharge. Larger studies are needed to assess the long-term impact on chronic pain and tumor recurrence by nonopioid techniques.
阿片类药物与术后恶心、呕吐、嗜睡及镇痛需求增加有关。一种非阿片类麻醉技术可能会降低发病率，使日间手术成为可能，并有可能减少肿瘤复发。在一项前瞻性队列研究中，我们比较了用于乳腺癌手术的无阿片类、基于神经阻滞的麻醉与基于阿片类的全身麻醉。
24例拟行改良根治性乳房切除术（MRM）并腋窝清扫术的美国麻醉医师协会I - III级成年患者，采用丙泊酚诱导麻醉，并通过i - gel在自主通气下以异氟烷（0.8 - 1.0最低肺泡浓度）维持麻醉，同时给予超声引导下的胸肌前锯肌1和2阻滞（0.1%利多卡因 + 0.25%布比卡因 + 1微克/千克右美托咪定，30毫升）。研究术后恶心、疼痛评分、24小时内非阿片类镇痛需求、在恢复室的停留时间以及外科医生和患者的满意度。24例在常规阿片类麻醉下接受MRM和腋窝清扫术且未进行神经阻滞的患者作为对照，采用控制通气。
所有患者在非阿片类技术下进行的MRM和腋窝清扫术均充分。非阿片类组在恢复室的停留时间、术后恶心、镇痛需求以及视觉模拟量表评分均显著更低。外科医生和患者对第7天患者良好的生活质量感到满意。
非阿片类神经阻滞技术对于行腋窝清扫的MRM是充分且安全的。与传统技术相比，它发病率更低，可能允许更早出院。需要更大规模的研究来评估非阿片类技术对慢性疼痛和肿瘤复发的长期影响。
