Parikh Rajiv P, Myckatyn Terence M
Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, MO, USA,
J Pain Res. 2018 Aug 23;11:1567-1581. doi: 10.2147/JPR.S148544. eCollection 2018.
The management of postoperative pain is of critical importance for women undergoing breast reconstruction after surgical treatment for breast cancer. Mitigating postoperative pain can improve health-related quality of life, reduce health care resource utilization and costs, and minimize perioperative opiate use. Multimodal analgesia pain management strategies with nonopioid analgesics have improved the value of surgical care in patients undergoing various operations but have only recently been reported in reconstructive breast surgery. Regional anesthesia techniques, with paravertebral blocks (PVBs) and transversus abdominis plane (TAP) blocks, and enhanced recovery after surgery (ERAS) pathways have been increasingly utilized in opioid-sparing multimodal analgesia protocols for women undergoing breast reconstruction. The objectives of this review are to 1) comprehensively review regional anesthesia techniques in breast reconstruction, 2) outline important components of ERAS protocols in breast reconstruction, and 3) provide evidence-based recommendations regarding each intervention included in these protocols. The authors searched across six databases to identify relevant articles. For each perioperative intervention included in the ERAS protocols, the literature was exhaustively reviewed and evidence-based recommendations were generated using the Grading of Recommendations, Assessment, Development, and Evaluation system methodology. This study provides a comprehensive evidence-based review of interventions to optimize perioperative care and postoperative pain control in breast reconstruction. Incorporating evidence-based interventions into future ERAS protocols is essential to ensure high value care in breast reconstruction.
对于接受乳腺癌手术治疗后进行乳房重建的女性而言，术后疼痛管理至关重要。减轻术后疼痛可改善与健康相关的生活质量，减少医疗资源的使用和成本，并尽量减少围手术期阿片类药物的使用。使用非阿片类镇痛药的多模式镇痛疼痛管理策略提高了接受各种手术患者的手术护理价值，但直到最近才在乳房重建手术中得到报道。区域麻醉技术，如椎旁阻滞（PVB）和腹横肌平面（TAP）阻滞，以及术后加速康复（ERAS）路径，已越来越多地用于接受乳房重建的女性的阿片类药物节省多模式镇痛方案中。本综述的目的是：1）全面回顾乳房重建中的区域麻醉技术；2）概述乳房重建中ERAS方案的重要组成部分；3）就这些方案中包含的每种干预措施提供基于证据的建议。作者在六个数据库中进行搜索以识别相关文章。对于ERAS方案中包含的每种围手术期干预措施，对文献进行了详尽的回顾，并使用推荐分级、评估、制定和评价系统方法生成了基于证据的建议。本研究对优化乳房重建围手术期护理和术后疼痛控制的干预措施进行了全面的循证综述。将基于证据的干预措施纳入未来的ERAS方案对于确保乳房重建中的高价值护理至关重要。
