Rivedal David D, Nayar Harry S, Israel Jacqueline S, Leverson Glen, Schulz Andrew J, Chambers Tamara, Afifi Ahmed M, Blake Jocelyn M, Poore Samuel O
Division of Plastic Surgery and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, G5/347 Clinical Science Center, Madison, Wisconsin.
Department of Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health, K6/446 Clinical Science Center, Madison, Wisconsin.
J Surg Res. 2018 Aug;228:307-313. doi: 10.1016/j.jss.2018.03.018. Epub 2018 Apr 25.
In light of data finding that postoperative pain, nausea, and vomiting worsen outcomes, a renewed emphasis has been placed on optimizing the perioperative period. Use of preoperative paravertebral block (PVB) has been shown to reduce opioid administration and postoperative nausea and vomiting (PONV) in many surgical populations, though its role in reduction mammaplasty remains undefined. Therefore, we seek to evaluate PVB as an adjunct to general anesthesia (GA) for reduction mammaplasty.
We reviewed records for patients who underwent reduction mammaplasty at our institution from 2010 to 2015. Patients were categorized into two groups: GA alone and GA + PVB (GA with PVB adjunct). Demographic information, opioid administration, phase I/II pain scores, presence of PONV, and anesthesia time were analyzed. Analysis was performed using t-tests and Fisher's exact test, with P-values less than 0.05 statistically significant.
We identified 264 patients meeting criteria: 209 (79%) received GA alone and 55 (21%) received GA + PVB. Intraoperative opioid administration were lower for GA + PVB patients (morphine equivalent of 44 mg versus 35 mg, P = 0.019), though there was no difference in postoperative opioid administration (P = 0.915). Phase I and II pain scores were significantly lower for those receiving PVB (2.9 versus 3.9, P = 0.012, and 3.0 versus 4.2, P = 0.001, respectively). GA + PVB was associated with less PONV (14% versus 33%, P = 0.007) and longer anesthesia times (271 min versus 236 min; P = 0.001).
By improving pain control and reducing PONV, factors known to be associated with poor patient satisfaction and inferior outcomes, PVB is an attractive anesthetic adjunct in elective breast surgery.
鉴于数据表明术后疼痛、恶心和呕吐会使预后恶化，人们重新强调优化围手术期。术前椎旁阻滞（PVB）的使用已被证明可减少许多手术人群的阿片类药物使用及术后恶心和呕吐（PONV），但其在缩乳术中的作用仍不明确。因此，我们试图评估PVB作为缩乳术全身麻醉（GA）辅助手段的效果。
我们回顾了2010年至2015年在我院接受缩乳术患者的记录。患者分为两组：单纯GA组和GA + PVB组（GA联合PVB辅助）。分析人口统计学信息、阿片类药物使用情况、I/II期疼痛评分、PONV的发生情况及麻醉时间。采用t检验和Fisher精确检验进行分析，P值小于0.05具有统计学意义。
我们确定了264例符合标准的患者：209例（79%）接受单纯GA，55例（21%）接受GA + PVB。GA + PVB组患者术中阿片类药物使用量较低（吗啡当量为44 mg对35 mg，P = 0.019），但术后阿片类药物使用量无差异（P = 0.915）。接受PVB患者的I期和II期疼痛评分显著更低（分别为2.9对3.9，P = 0.012；3.0对4.2，P = 0.001）。GA + PVB与更少的PONV相关（14%对33%，P = 0.007）且麻醉时间更长（271分钟对236分钟；P = 0.001）。
通过改善疼痛控制和减少PONV（已知与患者满意度低和预后差相关的因素），PVB是择期乳房手术中一种有吸引力的麻醉辅助手段。
