Department of Anaesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Surgery, Nagoya University Hospital, Nagoya, Japan.
Anaesthesia. 2019 Dec;74(12):1558-1562. doi: 10.1111/anae.14856. Epub 2019 Sep 19.
Thoracic interfascial plane blocks are effective for post-mastectomy acute analgesia. However, their effects on chronic pain are uncertain. We randomly allocated 80 women equally to pectoral nerve-2 (PECS 2) block or serratus plane block. The pectoral nerve-2 block reduced the rate of moderate or severe chronic pain from 13/40 (33%) with the serratus plane block to 4/40 (10%), p = 0.03, adjusted odds ratio (95%CI) 0.23 (0.07-0.80), p = 0.02. The rates of pain-free women at six postoperative months were indeterminate, 10/40 (25%) after serratus plane block vs. 19/40 (48%) after pectoral nerve-2 block, p = 0.06, adjusted odds ratio (95%CI) 2.9 (1.1-7.5), p = 0.03. Health-related quality of life at six postoperative months was similar after serratus plane and pectoral nerve-2 blocks, mean (SD) EQ-5D-3L scores 0.87 (0.15) vs. 0.91 (0.14), respectively, p = 0.21. The pectoral nerve-2 block reduced median (IQR [range]) morphine consumption in the first 24 postoperative hours from 6 (3-9 [1-25]) mg to 4 (2-7 [0-37]) mg, p = 0.04. However, acute pain scores after serratus plane and pectoral nerve-2 blocks were similar, median (IQR [range]) 23 (11-35 [0-70]) mm vs. 18 (11-27 [0-61]) mm, respectively, p = 0.44. Pectoral nerve-2 block reduced chronic pain 6 months after mastectomy compared with serratus plane block.
胸肌间平面阻滞可有效缓解乳腺癌根治术后急性疼痛，但对慢性疼痛的效果尚不确定。我们将 80 名女性患者随机等分为胸肌间神经阻滞（胸 2 神经阻滞）组和前锯肌平面阻滞组。与前锯肌平面阻滞组相比，胸肌间神经阻滞组中度或重度慢性疼痛的发生率从 13/40（33%）降至 4/40（10%），差异有统计学意义（P=0.03），调整后的比值比（95%CI）为 0.23（0.07-0.80），P=0.02。术后 6 个月时，两组无痛患者的比例均不确定，前锯肌平面阻滞组为 10/40（25%），胸肌间神经阻滞组为 19/40（48%），差异无统计学意义（P=0.06），调整后的比值比（95%CI）为 2.9（1.1-7.5），P=0.03。术后 6 个月两组患者的健康相关生活质量评分相似，EQ-5D-3L 评分分别为 0.87（0.15）和 0.91（0.14），差异无统计学意义（P=0.21）。与前锯肌平面阻滞相比，胸肌间神经阻滞组术后 24 小时内吗啡累计消耗量中位数（IQR[范围]）从 6（3-9[1-25]）mg 降至 4（2-7[0-37]）mg，差异有统计学意义（P=0.04）。但两组术后即刻急性疼痛评分相似，中位数（IQR[范围]）分别为 23（11-35[0-70]）mm 和 18（11-27[0-61]）mm，差异无统计学意义（P=0.44）。与前锯肌平面阻滞相比，乳腺癌根治术后 6 个月时，胸肌间神经阻滞可降低慢性疼痛发生率。
