Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC.
Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC.
Ann Vasc Surg. 2021 Jul;74:281-286. doi: 10.1016/j.avsg.2020.12.038. Epub 2021 Feb 4.
The transaxillary approach to resection of the first rib is one of several operative techniques for treating thoracic outlet syndrome. Unfortunately, moderate to severe postoperative pain is anticipated for patients undergoing this particular operation. While opioids can be used for analgesia, they have well-described side effects that has led investigators to search for clinically relevant alternative analgesic modalities. We hypothesized that a regional analgesic procedure, commonly called a pectoral nerve (PECS II) block, which anesthetizes the second through sixth intercostal nerves as well as the long thoracic nerve and the medial and lateral pectoral nerves, would improve postoperative analgesia for patients undergoing a transaxillary first rib resection.
We performed a retrospective study by reviewing the charts of all patients that had undergone a transaxillary first rib resection for thoracic outlet syndrome during the defined study period. Patients that received a PECS II block were compared to those that did not. The primary outcome was a comparison of numeric rating scale pain scores during the first 24 hours following the operation. Secondary outcomes included cumulative opioid consumption during the same time period.
Pain scores during the first 24 hours following the operation were not statistically different between groups (Block Group: 3.9 [2.1-5.3] [median (IQR 25-75%)] versus Non-block Group: 3.6 [2.4-4.1]; P = 0.40. In addition, opioid use through the first 24 hours after the operation was not significantly different (43.5 [22.0-81.0] [median morphine equivalents in mg's] versus 42.0 [12.5-75.0]; P = 0.53).
An ultrasound-guided PECS II nerve block did not reduce postoperative pain scores or opioid consumption for patients undergoing a transaxillary first rib resection. However, a prospective, randomized, study with improved power would be beneficial to further explore the potential utility of a PECS II block for patients presenting for this surgical procedure.
经腋窝入路切除第一肋骨是治疗胸廓出口综合征的几种手术技术之一。不幸的是，接受这种特殊手术的患者预计会出现中度至重度术后疼痛。虽然阿片类药物可用于镇痛，但它们具有明显的副作用，这促使研究人员寻找具有临床相关性的替代镇痛方式。我们假设一种区域镇痛程序，通常称为胸肌神经（PEC Ⅱ）阻滞，它可以麻醉第二至第六肋间神经以及胸长神经和胸内、外侧神经，将改善接受经腋窝第一肋骨切除术的患者的术后镇痛效果。
我们通过回顾在规定的研究期间接受经腋窝第一肋骨切除治疗胸廓出口综合征的所有患者的图表进行了回顾性研究。比较了接受 PECS Ⅱ阻滞的患者和未接受阻滞的患者。主要结局是比较术后 24 小时内数字评分量表的疼痛评分。次要结局包括同期累积阿片类药物消耗量。
术后 24 小时内，两组的疼痛评分无统计学差异（阻滞组：3.9 [2.1-5.3] [中位数（IQR 25-75%]与非阻滞组：3.6 [2.4-4.1]；P=0.40）。此外，术后 24 小时内阿片类药物的使用量也无显著差异（43.5 [22.0-81.0] [中位数吗啡等效物用量为 mg]与 42.0 [12.5-75.0]；P=0.53）。
超声引导下的 PECS Ⅱ神经阻滞并不能降低接受经腋窝第一肋骨切除术的患者的术后疼痛评分或阿片类药物的使用量。然而，一项具有更大效能的前瞻性、随机研究将有助于进一步探索 PECS Ⅱ阻滞在接受这种手术的患者中的潜在效用。
