Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Br J Anaesth. 2019 Aug;123(2):e293-e302. doi: 10.1016/j.bja.2019.01.041. Epub 2019 Mar 28.
Previous studies suggest that truncal regional anaesthesia (TRA), including techniques such as paravertebral block, may contribute significantly to analgesia after mastectomy. However, the severity and impact of postoperative pain varies markedly amongst individuals, making the identification of patients who would benefit most from TRA a potentially important step toward personalised perioperative care.
In this prospective observational study, mastectomy patients (n=122) were recruited and systematically assessed for psychosocial characteristics including pain catastrophising before surgery, and either received preoperative TRA (n=57) or no block (n=65).
Age, baseline pain, and psychosocial traits did not differ between these groups. TRA was associated with lower overall pain scores and opioid consumption perioperatively, with a larger proportion of patients without block (50% vs 28%) reporting moderate-severe pain (more than three/10) on the day of surgery. Mixed model analysis of variance revealed a significant interaction between catastrophising and TRA, such that amongst patients with high baseline catastrophising, TRA was associated with substantially lower pain severity score (58% lower), while amongst patients with low baseline catastrophising, TRA was associated with only 18% lower pain severity. At 2 weeks, this interaction between baseline catastrophising and TRA was also observed when examining surgical pain burden, with higher baseline catastrophising patients who had received TRA reporting lower pain and less frequent opioid use (40% vs 70% of patients).
TRA provided immediate analgesic benefit for patients undergoing mastectomy on the day of surgery, but this effect appeared more pronounced and sustained amongst patients with higher baseline catastrophising.
NCT02329574.
先前的研究表明，躯干区域麻醉（TRA），包括椎旁阻滞等技术，可能对乳房切除术后的镇痛有显著贡献。然而，个体之间术后疼痛的严重程度和影响差异很大，因此确定最受益于 TRA 的患者可能是个性化围手术期护理的重要一步。
在这项前瞻性观察研究中，招募了乳房切除术患者（n=122），并在手术前系统评估其社会心理特征，包括疼痛灾难化，然后为这些患者提供 TRA（n=57）或不进行阻滞（n=65）。
两组患者的年龄、基线疼痛和心理社会特征无差异。TRA 与围手术期的总体疼痛评分和阿片类药物消耗降低有关，无阻滞组（50%）报告手术当天中度至重度疼痛（超过 3/10）的患者比例高于阻滞组（28%）。方差混合模型分析显示，灾难化和 TRA 之间存在显著的交互作用，即在基线灾难化较高的患者中，TRA 与疼痛严重程度评分显著降低（降低 58%）有关，而在基线灾难化较低的患者中，TRA 仅与疼痛严重程度降低 18%有关。在 2 周时，当检查手术疼痛负担时，也观察到基线灾难化和 TRA 之间的这种相互作用，接受 TRA 的基线灾难化较高的患者报告疼痛更低且阿片类药物使用频率更低（40%的患者对 70%的患者）。
TRA 在手术当天为接受乳房切除术的患者提供了即时的镇痛益处，但在基线灾难化较高的患者中，这种效果似乎更明显且持续。
NCT02329574。
