Nair Ganeshkrishna, Wong Danny J, Chan Edmund, Alexander Tamara, Jeevananthan Rajeev, Pawa Amit
Anaesthesia, Guy's & St Thomas' National Health Service (NHS) Foundation Trust, London, GBR.
Cureus. 2021 Mar 11;13(3):e13822. doi: 10.7759/cureus.13822.
Regional anesthesia techniques may improve patient recovery beyond treating postoperative pain alone and may facilitate patients in their return to functional, psychological as well as emotional baselines. We hypothesized that the quality of recovery (QoR) experienced by patients following breast surgery was associated with the type of anesthesia received as well as the use of a regional anesthesia technique during surgery.
We performed a single-center prospective, observational cohort study of patients undergoing elective breast procedures (both cancer and non-cancer surgery).
One hundred patients completed baseline QoR-15 questionnaires prior to surgery, of which 96 also completed QoR-15 questionnaires on postoperative day 1. The median (IQR) QoR-15 score at baseline was 133 (124-141), decreasing to 121 (106.75-136.25) on postoperative day 1. In multivariable linear regression analysis, paravertebral blocks (PVB) were associated with a 16.7 point higher overall QoR-15 score on postoperative day 1 compared to no block (95% Confidence Interval [CI]: 7.7-25.8, p<0.001); while the use of combination blocks was associated with a 21.8 point higher postoperative QoR-15 score compared to no block (95% CI: 12.8-30.8, p<0.001). PVB and combination blocks were further associated with better postoperative pain, physical comfort, physical independence and emotional state scores, compared with no block. The use of total intravenous anesthetic was not associated with differences in postoperative QoR-15 score versus volatile anesthetic, after covariate adjustment.
Breast surgery patients receiving PVB or a combination of regional blocks during surgery have higher postoperative QoR-15 scores, after adjustment for other factors.
区域麻醉技术可能不仅通过治疗术后疼痛来改善患者恢复情况，还可能有助于患者恢复到功能、心理以及情绪基线状态。我们假设接受乳房手术患者的恢复质量（QoR）与所接受的麻醉类型以及手术期间区域麻醉技术的使用有关。
我们对接受择期乳房手术（包括癌症和非癌症手术）的患者进行了一项单中心前瞻性观察队列研究。
100名患者在手术前完成了基线QoR - 15问卷，其中96名患者在术后第1天也完成了QoR - 15问卷。基线时QoR - 15评分的中位数（IQR）为133（124 - 141），术后第1天降至121（106.75 - 136.25）。在多变量线性回归分析中，与未进行阻滞相比，椎旁阻滞（PVB）在术后第1天的总体QoR - 15评分高16.7分（95%置信区间[CI]：7.7 - 25.8，p<0.001）；而与未进行阻滞相比，联合阻滞的使用使术后QoR - 15评分高21.8分（95%CI：12.8 - 30.8，p<0.001）。与未进行阻滞相比，PVB和联合阻滞还与更好的术后疼痛、身体舒适度、身体独立性和情绪状态评分相关。在进行协变量调整后，与挥发性麻醉剂相比，全静脉麻醉剂的使用与术后QoR - 15评分差异无关。
在调整其他因素后，手术期间接受PVB或区域阻滞联合使用的乳房手术患者术后QoR - 15评分更高。
