Goeteyn Jens, van den Broek Renee, Bouwman Arthur, Pesser Niels, van Nuenen Bart, van Sambeek Marc, Houterman Saskia, Teijink Joep, Versyck Barbara
Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands.
Department of Anaesthesiology, Catharina Hospital, Eindhoven, the Netherlands.
Ann Vasc Surg. 2020 Jul;66:301-308. doi: 10.1016/j.avsg.2019.12.005. Epub 2019 Dec 16.
Postoperative analgesia in patients undergoing transaxillary thoracic outlet decompression (TATOD) is challenging because of the invasive surgery, the complex innervation of the axillary region, and the preoperative use of opioids by many patients. Commonly, postoperative pain is managed with additional opioids that introduce well-known sideeffects. To investigate the analgesic efficacy of 2 novel regional anesthesia techniques, we performed a retrospective study comparing the combined pectoral block type 1 and erector spinae block (PECS 1 + ESB) and the pectoral block type 2 (PECS 2) and systemic intravenous opioids regimen (no block) in patients undergoing TATOD.
We performed 10 PECS 1 + ESB and 10 PECS 2 blocks in patients undergoing TATOD. Twenty patients were randomly selected as controls. The primary endpoint was pain. Secondary endpoints were opioid use, nausea, and vomiting.
Postoperative maximal numeric rating scale scores on recovery were significantly lower in patients receiving either a PECS 1 + ESB or a PECS 2 block compared with controls without block (no block: median 6.00, interquartile range [IQR] 3.00; PECS 1 + ESB: median 4.50, IQR 4.00; PECS 2: median 4.00, IQR 5.00; P = 0.031). Postoperative intravenous morphine consumption was 43% lower in the PECS 1 + ESB group and 56% lower in the PECS 2 group compared with the group with no block (oral morphine equivalents; no block: mean 16.05 ± SD 6.79 mg; PECS 1 + ESB mean 9.05 ± SD 6.24 mg; PECS 2: mean 7.00 ± SD 6.16; P = 0.03 and P = 0.003, respectively). There was no statistical difference in both nausea and vomitus (no block 45% nausea and 30% vomitus, PECS 1 + ESB 40% nausea and 20% vomitus, PECS 2 10% nausea and 0% vomitus, P = 0.17 and P = 0.14, respectively).
There was a significant reduction in postoperative pain and opioid consumption for patients treated with either the PECS 1 + ESB block or PECS 2.
经腋下胸廓出口减压术（TATOD）患者的术后镇痛具有挑战性，这是由于手术具有侵入性、腋窝区域神经支配复杂，且许多患者术前使用了阿片类药物。通常，术后疼痛通过额外使用阿片类药物来控制，但这些药物会带来众所周知的副作用。为了研究两种新型区域麻醉技术的镇痛效果，我们进行了一项回顾性研究，比较了1型联合胸肌阻滞和竖脊肌阻滞（PECS 1 + ESB）、2型胸肌阻滞（PECS 2）以及全身静脉注射阿片类药物方案（无阻滞）在接受TATOD患者中的应用。
我们对接受TATOD的患者进行了10例PECS 1 + ESB和10例PECS 2阻滞。随机选择20例患者作为对照。主要终点是疼痛。次要终点是阿片类药物使用、恶心和呕吐。
与未接受阻滞的对照组相比，接受PECS 1 + ESB或PECS 2阻滞的患者术后恢复时的最大数字评分量表得分显著更低（无阻滞：中位数6.00，四分位间距[IQR] 3.00；PECS 1 + ESB：中位数4.50，IQR 4.00；PECS 2：中位数4.00，IQR 5.00；P = 0.031）。与无阻滞组相比，PECS 1 + ESB组术后静脉注射吗啡的消耗量降低了43%，PECS 2组降低了56%（口服吗啡当量；无阻滞：平均16.05±标准差6.79 mg；PECS 1 + ESB平均9.05±标准差6.24 mg；PECS 2：平均7.00±标准差6.16；P分别为0.03和0.003）。恶心和呕吐方面均无统计学差异（无阻滞组恶心45%、呕吐30%，PECS 1 + ESB组恶心40%、呕吐20%，PECS 2组恶心10%、呕吐0%，P分别为0.17和0.14）。
接受PECS 1 + ESB阻滞或PECS 2治疗的患者术后疼痛和阿片类药物消耗量显著降低。
