ElHawary Hassan, Joshi Girish P, Janis Jeffrey E
Division of Plastic and Reconstructive Surgery, McGill University, Montreal, QC, Canada.
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Tex.
Plast Reconstr Surg Glob Open. 2020 Dec 17;8(12):e3224. doi: 10.1097/GOX.0000000000003224. eCollection 2020 Dec.
Regional analgesia has been increasing in popularity due to its opioid- sparing analgesic effects and utility in multimodal analgesia strategies. Several regional techniques have been used in plastic surgery; however, there is a lack of consensus on the indications and the comparative efficacy of these blocks. The goal of this review is to provide evidence-based recommendations on the most relevant types of interfascial plane blocks for abdominal and breast surgery. A systematic search of the PUBMED, EMBASE, and Cochrane databases was performed to identify the evidence associated with the different interfascial plane blocks used in plastic surgery. The search included all studies from inception to March 2020. A total of 126 studies were included and used in the synthesis of the information presented in this review. There is strong evidence for using the transversus abdominis plane blocks in both abdominoplasties as well as abdominally-based microvascular breast reconstruction as evidenced by a significant reduction in post-operative pain and opioid consumption. Pectoralis (I and II), serratus anterior, and erector spinae plane blocks all provide good pain control in breast surgeries. Finally, the serratus anterior plane block can be used as primary block or an adjunct to the pectoralis blocks for a wider analgesia coverage of the breast. All the reviewed blocks are safe and easy to administer. Interfascial plane blocks are effective and safe modalities used to reduce pain and opioid consumption after abdominal and breast plastic surgery.
区域镇痛因其节省阿片类药物的镇痛效果以及在多模式镇痛策略中的应用而越来越受欢迎。整形外科中已经使用了几种区域技术；然而，对于这些阻滞的适应症和比较疗效缺乏共识。本综述的目的是为腹部和乳房手术中最相关的筋膜间平面阻滞类型提供基于证据的建议。对PUBMED、EMBASE和Cochrane数据库进行了系统检索，以确定与整形外科中使用的不同筋膜间平面阻滞相关的证据。检索包括从开始到2020年3月的所有研究。总共纳入了126项研究，并用于本综述所呈现信息的综合分析。有强有力的证据表明，在腹部整形手术以及基于腹部的微血管乳房重建中使用腹横肌平面阻滞，术后疼痛和阿片类药物消耗量显著减少。胸肌（I和II）、前锯肌和竖脊肌平面阻滞在乳房手术中均能提供良好的疼痛控制。最后，前锯肌平面阻滞可作为主要阻滞或胸肌阻滞的辅助阻滞，以实现更广泛的乳房镇痛覆盖范围。所有综述的阻滞均安全且易于实施。筋膜间平面阻滞是用于减少腹部和乳房整形手术后疼痛和阿片类药物消耗量的有效且安全的方法。
