Homsy Christopher, Lindsey John T
From the Division of Plastic and Reconstructive Surgery, Tulane University, New Orleans, LA.
Ann Plast Surg. 2019 Jun;82(6S Suppl 5):S374-S379. doi: 10.1097/SAP.0000000000001805.
With the introduction of latest generation ultrasound technology and its easy availability and portability, regional anesthetic blocks, which were formally in the domain of anesthesiologists, have now become available to practicing plastic surgeons. Enhanced Recovery After Surgery protocols for other specialties such as orthopedics and colorectal surgery have incorporated regional anesthetic blocks. These regional blocks have been shown to be effective in improving the patient comfort and experience and decreasing reliance on opioid medications.
Patients scheduled for elective plastic surgery received PEC-1, serratus anterior plane, or transversus abdominis plane blocks as indicated for the proposed procedure. All blocks were performed under ultrasound guidance using the Philips Lumify system with the linear array 12-4 probe by the operating surgeon.
A total of 83 patients received regional anesthetic blocks by the senior author. Thirty-three patients undergoing cosmetic breast augmentation or implant-based breast reconstruction received the PEC-1 and the serratus anterior plane blocks after the induction of anesthesia but before the prep and drape. Fifty patients undergoing either abdominoplasty or deep inferior epigastric perforator flap reconstruction received intraoperative transversus abdominis plane blocks. Anatomic planes were clearly visualized with this new ultrasound technology. Patients experienced good to excellent analgesia with less reliance on opioid medications and decreased need for refills. For hospitalized patients, length of stay in some cases was decreased up to 1 day, and PCA pumps were eliminated. There were no complications or adverse sequelae observed in any of these patients related to the regional blocks.
Incorporation of these known regional anesthetic techniques in this single-surgeon experience seems to confirm reports of effectiveness in the anesthesia literature and may be of benefit to a wide range of plastic surgery patients.
随着最新一代超声技术的引入，以及其易于获取和便携性，以往属于麻醉医生领域的区域麻醉阻滞，如今已可供整形外科医生使用。骨科和结直肠外科等其他专科的术后加速康复方案已纳入区域麻醉阻滞。这些区域阻滞已被证明在提高患者舒适度和体验以及减少对阿片类药物的依赖方面是有效的。
计划进行择期整形手术的患者根据拟行手术的需要接受PEC-1阻滞、前锯肌平面阻滞或腹横肌平面阻滞。所有阻滞均在超声引导下，由手术医生使用配备线性阵列12-4探头的飞利浦Lumify系统进行。
资深作者共为83例患者实施了区域麻醉阻滞。33例行美容隆胸或乳房假体植入重建术的患者在麻醉诱导后、铺巾前接受了PEC-1阻滞和前锯肌平面阻滞。50例行腹部整形术或腹壁下深动脉穿支皮瓣重建术的患者在术中接受了腹横肌平面阻滞。这种新的超声技术能清晰显示解剖平面。患者镇痛效果良好至极佳，对阿片类药物的依赖减少，且补充用药需求降低。对于住院患者，在某些情况下住院时间缩短了1天，且无需使用自控镇痛泵。这些患者中未观察到与区域阻滞相关的并发症或不良后遗症。
在这位单名外科医生的经验中纳入这些已知的区域麻醉技术，似乎证实了麻醉学文献中关于其有效性的报道，可能对广泛的整形外科患者有益。
