肿瘤整形乳房手术中椎旁阻滞与出院时疼痛评分的相关性：一项回顾性队列研究。
Association between Paravertebral Block and Pain Score at the Time of Hospital Discharge in Oncoplastic Breast Surgery: A Retrospective Cohort Study.
作者信息
Buzney Catherine D, Lin Liz Z, Chatterjee Abhishek, Gallagher Sean W, Quraishi Sadeq A, Drzymalski Dan M
机构信息
From the Departments of Anesthesiology and Perioperative Medicine and Surgery, Tufts Medical Center; and Tufts University School of Medicine., Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, 800 Washington Street, Box 298, Boston, Mass. 02111.
出版信息
Plast Reconstr Surg. 2021 Jun 1;147(6):928e-935e. doi: 10.1097/PRS.0000000000007942.
BACKGROUND
Using nonopioid analgesics may decrease the risk of patients chronically using opioids postoperatively. The authors evaluated the relationship between paravertebral block and pain score at the time of hospital discharge.
METHODS
The authors performed a retrospective cohort study of 89 women with American Society of Anesthesiologists Physical Status I to III undergoing oncoplastic breast surgery with 20 to 50 percent breast tissue removal and immediate contralateral reconstruction between August of 2015 and August of 2018. The primary outcome was pain score at hospital discharge with or without paravertebral block. The secondary outcome was postoperative length of stay. Data were analyzed using the Wilcoxon rank sum test, t test, Fisher's exact test, univariable and multivariable regression, Kaplan-Meier analyses, and Cox regression.
RESULTS
Median pain score at hospital discharge was lower with paravertebral block [2 (interquartile range, 0 to 2) compared to 4 (interquartile range, 3 to 5); p < 0.001]. Multivariable regression revealed that pain score at the time of hospital discharge was inversely associated with paravertebral block after adjusting for age, body mass index, American Society of Anesthesiologists class, extent of lymph node surgery, and duration of surgery (p < 0.001). Pain score at hospital discharge was also associated with total opioid consumption during the first 24 hours after surgery (p = 0.001). Patients who received paravertebral blocks had median total 24-hour postoperative opioid consumption in morphine equivalents of 7 mg (interquartile range, 3 to 10 mg) compared with 13 mg (interquartile range, 7 to 18 mg) (p < 0.001), and median length of stay of 18 hours (interquartile range, 16 to 20 hours) compared with 22 hours (interquartile range, 21 to 27 hours) (p < 0.001).
CONCLUSION
Paravertebral blocks are associated with decreased pain score at the time of hospital discharge.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
使用非阿片类镇痛药可能会降低患者术后长期使用阿片类药物的风险。作者评估了椎旁阻滞与出院时疼痛评分之间的关系。
方法
作者对2015年8月至2018年8月期间89例美国麻醉医师协会身体状况I至III级、接受肿瘤整形乳房手术且切除20%至50%乳腺组织并同期进行对侧即刻重建的女性患者进行了一项回顾性队列研究。主要结局是出院时有无椎旁阻滞的疼痛评分。次要结局是术后住院时间。采用Wilcoxon秩和检验、t检验、Fisher精确检验、单变量和多变量回归、Kaplan-Meier分析以及Cox回归分析数据。
结果
椎旁阻滞组出院时的疼痛评分中位数较低[2（四分位间距，0至2），而未行椎旁阻滞组为4（四分位间距，3至5）；p<0.001]。多变量回归显示，在调整年龄、体重指数、美国麻醉医师协会分级、淋巴结手术范围和手术持续时间后，出院时的疼痛评分与椎旁阻滞呈负相关（p<0.001）。出院时的疼痛评分还与术后24小时内的总阿片类药物消耗量相关（p=0.001）。接受椎旁阻滞的患者术后24小时阿片类药物总消耗量中位数以吗啡当量计为7mg（四分位间距，3至1mg），而未行椎旁阻滞组为13mg（四分位间距，7至18mg）（p<0.001），住院时间中位数为18小时（四分位间距，16至20小时），未行椎旁阻滞组为22小时（四分位间距，21至27小时）（p<0.001）。
结论
椎旁阻滞与出院时疼痛评分降低有关。
临床问题/证据水平：治疗性，III级。
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