Wang Xunxun, Ran Guo, Chen Xia, Xie Cuiyu, Wang Jing, Liu Xuesheng, Lu Yao, Fang Weiping
Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.
Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China.
Pain Ther. 2021 Jun;10(1):475-484. doi: 10.1007/s40122-020-00234-9. Epub 2021 Jan 21.
One of the most common malignancies in women worldwide is breast cancer. Erector spinae plane block (ESPB) can reduce pain after modified radical mastectomy for breast cancer. The duration of nerve block analgesia is limited if local anesthetic agents are used alone. The purpose of this study was to evaluate the effect of dexmedetomidine on postoperative analgesia during a single injection of local anesthetics.
In this double-blind, randomized study, 60 female American Society of Anesthesiologists (ASA) I-II patients undergoing modified radical mastectomy were randomized into two groups: ultrasound (US)-guided ESPB with 30 mL of 0.33% ropivacaine (group R) and US-guided ESPB with 30 mL of dexmedetomidine plus 0.33% ropivacaine (group DR). US-guided ESPB at the T3 vertebral level was performed preoperatively in all patients. The indicators were 1-, 6-, 12-, 24-, and 48-h visual analog scale (VAS) pain scores after surgery in the resting state and at 90-degree shoulder abduction. Other measures were a comparison of intraoperative sufentanil and remifentanil, postoperative nausea and vomiting (PONV), flurbiprofen consumption, the lengths of post-anesthesia care unit (PACU) stay and hospital stay, postoperative bradycardia, and hypotension.
The VAS pain score was lower in group DR than group R at any time in the resting state, except at 1 h after surgery. The VAS pain score was lower in group DR than group R at 12 and 24 h in an active state after surgery (P < 0.05 for each time interval). The intraoperative dosages of remifentanil and sufentanil in group DR were lower than that in group R. The postoperative dosage of flurbiprofen in group DR was lower than that in group R (P = 0.038). The lengths of PACU stay were longer in group DR than in group R. No significant difference was found in PONV and hospital stay between the two groups. No sinus bradycardia or hypotension after surgery occurred in the two groups.
Dexmedetomidine as an adjunctive to ESPB can effectively relieve pain and significantly reduce the need for opioids during modified radical mastectomy for breast cancer.
The study was registered in the Chinese Clinical Trial Registry (ChiCTR2000031134, principal investigator: Yao Lu, date of registration: 2020-3-22).
乳腺癌是全球女性中最常见的恶性肿瘤之一。竖脊肌平面阻滞（ESPB）可减轻乳腺癌改良根治术后的疼痛。若单独使用局部麻醉药，神经阻滞镇痛的持续时间有限。本研究旨在评估右美托咪定在单次注射局部麻醉药时对术后镇痛的效果。
在这项双盲、随机研究中，60例接受乳腺癌改良根治术的美国麻醉医师协会（ASA）I-II级女性患者被随机分为两组：超声（US）引导下接受30 mL 0.33%罗哌卡因的ESPB（R组）和超声引导下接受30 mL右美托咪定加0.33%罗哌卡因的ESPB（DR组）。所有患者术前均在T3椎体水平进行超声引导下的ESPB。观察指标为术后1、6、12、24和48小时静息状态及肩部外展90度时的视觉模拟评分（VAS）疼痛评分。其他指标包括术中舒芬太尼和瑞芬太尼的用量比较、术后恶心呕吐（PONV）、氟比洛芬用量、麻醉后恢复室（PACU）停留时间和住院时间、术后心动过缓和低血压情况。
除术后1小时外，DR组在静息状态下任何时间的VAS疼痛评分均低于R组。术后活动状态下，DR组在术后12和24小时的VAS疼痛评分低于R组（各时间间隔P均<0.05）。DR组术中瑞芬太尼和舒芬太尼用量低于R组。DR组术后氟比洛芬用量低于R组（P = 0.038）。DR组PACU停留时间长于R组。两组在PONV和住院时间方面未发现显著差异。两组术后均未发生窦性心动过缓或低血压。
右美托咪定作为ESPB的辅助用药，可有效缓解乳腺癌改良根治术中的疼痛，并显著减少阿片类药物的使用需求。
本研究已在中国临床试验注册中心注册（ChiCTR2000031134，主要研究者：姚璐，注册日期：2020年3月22日）。
