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<编辑精选>胸长神经阻滞(Pecs II 阻滞)与前锯肌平面阻滞在乳腺癌手术后镇痛效果的比较:一项回顾性研究。

<Editors' Choice> Efficacy of pectoral nerve block type-2 (Pecs II block) versus serratus plane block for postoperative analgesia in breast cancer surgery: a retrospective study.

机构信息

Department of Anesthesiology, Nagoya University Hospital, Nagoya, Japan.

Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

出版信息

Nagoya J Med Sci. 2020 Feb;82(1):93-99. doi: 10.18999/nagjms.82.1.93.

Abstract

Thoracic wall nerve blocks reduce postoperative acute pain after breast cancer surgery (BCS); however, their short-term effects and the most effective technique remain unclear. To compare the effects of pectoral nerve block type-2 (Pecs II block) and serratus plane block for postoperative short-term analgesia, we retrospectively reviewed 43 BCS patients who underwent Pecs II block (=22) or serratus plane block (=21). The primary outcome was the proportion of patients with no complaints of pain 2 months post-BCS. The odds ratio (OR) was assessed, adjusting for axillary lymph node dissection. The secondary outcomes were pain severity 24 hours and 2 months post-operation using the numerical rating scale score, and morphine consumption within 24 hours. The proportion of patients without pain 2 months post-BCS was significantly less with Pecs II block than in patients with serratus plane block (55% vs. 19%, adjusted OR, 5.04; 95% confidence interval, 1.26-20.07; =0.02); the median [interquartile range] score for pain 2 months post-operation was also significantly lower with Pecs II block (Pecs II block 0.5 [0-1] vs. serratus plane block 1 [1-2]); =0.03). Regarding post-BCS acute analgesia, the median [interquartile range] postoperative 24-hour pain score was 2 [1-3] and 3 [1.5-3.5], and the median morphine consumption within 24 hours was 1.5 [0.75-5.5] and 3 [1.5-10] mg in Pecs II block and serratus plane block (=0.47 and =0.11), respectively. This study suggests that Pecs II block prevents short-term post-BCS pain better than serratus plane block. However, further studies are needed in order to support this finding.

摘要

胸壁神经阻滞可减少乳腺癌手术后的急性疼痛(BCS);然而,其短期效果和最有效的技术仍不清楚。为了比较 2 型胸肌神经阻滞(Pecs II 阻滞)和胸肌平面阻滞在术后短期镇痛方面的效果,我们回顾性分析了 43 例接受 Pecs II 阻滞(=22 例)或胸肌平面阻滞(=21 例)的 BCS 患者。主要结局是术后 2 个月无疼痛抱怨的患者比例。调整腋窝淋巴结清扫后,评估比值比(OR)。次要结局为术后 24 小时和 2 个月的疼痛严重程度(数字评分量表评分)和 24 小时内吗啡消耗量。术后 2 个月无疼痛的患者比例, Pecs II 阻滞组明显低于胸肌平面阻滞组(55%比 19%,调整 OR,5.04;95%置信区间,1.26-20.07;=0.02);术后 2 个月疼痛评分中位数(四分位距)也明显较低 Pecs II 阻滞组(Pecs II 阻滞 0.5 [0-1]比胸肌平面阻滞 1 [1-2]);=0.03)。关于术后急性镇痛,术后 24 小时疼痛评分中位数(四分位距)分别为 2 [1-3]和 3 [1.5-3.5],24 小时内吗啡消耗量中位数(四分位距)分别为 1.5 [0.75-5.5]和 3 [1.5-10]mg Pecs II 阻滞和胸肌平面阻滞组(=0.47 和 =0.11)。本研究表明, Pecs II 阻滞在预防短期乳腺癌手术后疼痛方面优于胸肌平面阻滞。然而,需要进一步的研究来支持这一发现。

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