Scheflan Michael, Allweis Tanir M
Plastic Surgeon, Scheflan Plastic Surgery, Tel Aviv, Israel.
Breast Surgeon, Assuta Medical Center and Kaplan Medical Center, Tel Aviv, Israel.
Aesthet Surg J Open Forum. 2020 Feb 27;2(1):ojaa009. doi: 10.1093/asjof/ojaa009. eCollection 2020 Jan.
With the heightened awareness of the dangers of opioid administration, the importance of providing effective non-opioid postoperative pain management is evident. Regional analgesia for breast surgery has been described, but it is unclear how widely it is utilized. The authors describe a simple block performed during ablative, aesthetic, and reconstructive breast surgery to improve postoperative pain control and significantly decrease the need for postoperative pain medications. The interpectoral (PECS I) block covers the lateral and medial pectoral nerves and can be administered by the anesthesiologist under ultrasound guidance after induction of general anesthesia, or by the surgeon under direct vision, using a blunt cannula, at the time of surgery. The authors have been practicing this technique in every patient undergoing aesthetic, ablative, and reconstructive breast surgery in the last 4 years. In approximately 350 patients, none received opioids after discharge, which was either same day or the following day. The authors provide a brief review of the literature and a detailed description of the technique along with a video demonstrating the procedures. Intraoperative pectoral block is a simple and effective technique for decreasing postoperative pain and analgesic requirements and could be widely adopted as a standard of care in breast surgery.
随着对阿片类药物给药风险的认识不断提高，提供有效的非阿片类术后疼痛管理的重要性不言而喻。已有关于乳腺手术区域镇痛的描述，但尚不清楚其应用的广泛程度。作者描述了一种在乳腺切除、美容和重建手术中实施的简单阻滞，以改善术后疼痛控制并显著减少术后止痛药物的需求。胸肌间（PECS I）阻滞覆盖胸外侧神经和胸内侧神经，可在全身麻醉诱导后由麻醉医生在超声引导下实施，或在手术时由外科医生直视下使用钝头套管针实施。在过去4年里，作者对每一位接受美容、切除和重建乳腺手术的患者都采用了这种技术。在大约350例患者中，没有患者在出院当天或次日出院后使用阿片类药物。作者提供了文献简要回顾、该技术的详细描述以及演示该操作的视频。术中胸肌阻滞是一种简单有效的减少术后疼痛和镇痛需求的技术，可广泛用作乳腺手术的标准治疗方法。
