Asserson Derek B, Sahar David E
California Northstate University College of Medicine, Elk Grove, CA, USA.
Division of Plastic Surgery, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, USA.
Arch Plast Surg. 2021 Jul;48(4):361-365. doi: 10.5999/aps.2020.01550. Epub 2021 Jul 15.
Pain in the postoperative body contouring patient has traditionally been managed with narcotic medication. In an effort to minimize side effects and prevent addiction, plastic surgeons are searching for novel ways to provide adequate analgesia, one of which is nerve blocks. This study was conducted with a meta-analysis that evaluates the efficacy of these blocks for patients who undergo breast surgery.
A search of the PubMed/MEDLINE database for articles including the terms "postoperative analgesia" OR "postoperative pain management" AND "in plastic surgery" OR "in cosmetic surgery" OR "in elective surgery" in February 2019 generated five studies on elective breast augmentation and reduction mammoplasty that reported pain scores and quantities of opioids consumed. Independent samples t-tests, one-way analysis of variance, and a random effects model were implemented for evaluation.
A total of 317 patients were identified as having undergone body contouring of the breast, about half of which received a nerve block. Pain scores on a 1-10 scale and opioid dose-equivalents were calculated. Those who were blocked had an average score of 2.40 compared to 3.64 for those who did not (P<0.001), and required an average of 5.20 less narcotic doses (P<0.001). Pain relief following subpectoral augmentation was best achieved with type-II blocks as opposed to type-I and type-II with serratus plane (P<0.001).
The opioid epidemic has extended to all surgical specialties. Implementation of a nerve block seems to be an efficacious and cost-effective mechanism to not only help with postoperative pain, but also lower the need for narcotics, especially in subpectoral augmentation.
传统上，术后身体塑形患者的疼痛是通过使用麻醉药物来控制的。为了尽量减少副作用并防止成瘾，整形外科医生正在寻找提供充分镇痛的新方法，其中之一就是神经阻滞。本研究通过荟萃分析评估这些阻滞对接受乳房手术患者的疗效。
2019年2月在PubMed/MEDLINE数据库中搜索包含“术后镇痛”或“术后疼痛管理”以及“整形外科”或“美容外科”或“择期手术”等术语的文章，共筛选出五项关于择期隆乳术和乳房缩小成形术的研究，这些研究报告了疼痛评分和阿片类药物的消耗量。采用独立样本t检验、单因素方差分析和随机效应模型进行评估。
共确定317例患者接受了乳房塑形手术，其中约一半接受了神经阻滞。计算了1-10分制的疼痛评分和阿片类药物剂量当量。接受阻滞的患者平均评分为2.40，未接受阻滞的患者平均评分为3.64（P<0.001），且所需麻醉剂量平均少5.20（P<0.001）。与I型阻滞以及I型和II型联合锯肌平面阻滞相比，II型阻滞在胸肌下隆乳术后的镇痛效果最佳（P<0.001）。
阿片类药物流行已蔓延至所有外科专业。实施神经阻滞似乎是一种有效且具有成本效益的机制，不仅有助于缓解术后疼痛，还能降低对麻醉药物的需求，尤其是在胸肌下隆乳术中。
