School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan.
Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
Aesthetic Plast Surg. 2022 Jun;46(3):1106-1115. doi: 10.1007/s00266-022-02815-9. Epub 2022 Mar 11.
Breast augmentation can cause severe postoperative pain; therefore, some surgeons perform wound infiltration with a local anesthetic solution. This study investigated the postoperative pain relief of local analgesics in breast augmentation surgery.
We searched three databases for randomized controlled trials evaluating the outcomes of local wound irrigation with local analgesics during or after breast augmentation surgery. The solutions included ropivacaine, bupivacaine, bupivacaine plus ketorolac. The control groups may be saline alone or no irrigation. Network meta-analysis was further employed based on the frequentist approach. Outcomes were reported as weighted mean differences with 95% confidence intervals.
Comparisons between the interventions of our included studies revealed that only bupivacaine plus ketorolac (versus placebo) significantly reduced pain at 1 h postoperatively, as indicated by the visual analog scale pain score reduction of 2.22 (- 3.98, - 0.47). Other comparisons showed no significant differences. Moreover, three of the included studies reported postoperative medication use. Two of them reported that postoperative narcotic use was reduced, but the others did not report any such reduction.
Our results showed possibility that local irrigation with bupivacaine plus ketorolac might reduce pain 1 h after surgery. In addition, local anesthesia might reduce postoperative narcotic use. However, due to the small number of included studies, the clinical benefits of local anesthesia in breast augmentation surgery require further confirmation.
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隆胸术后会引起严重的疼痛，因此一些外科医生会在切口局部浸润麻醉。本研究旨在评估隆胸术中局部应用局麻药减轻术后疼痛的效果。
我们检索了三个数据库，以评估在隆胸术中或术后局部灌洗局部麻醉药的结局。所使用的局麻药包括罗哌卡因、布比卡因、布比卡因+酮咯酸。对照组可以是生理盐水或不冲洗。进一步采用基于频率论的方法进行网络荟萃分析。结果表示为加权均数差值及其 95%置信区间。
与安慰剂相比，仅布比卡因+酮咯酸（与安慰剂相比）可显著减轻术后 1 小时的疼痛，视觉模拟评分降低 2.22 分（-3.98，-0.47）。其他比较无显著差异。此外，纳入的三项研究报告了术后药物使用情况。其中两项报告术后阿片类药物使用减少，但其他研究没有报告任何减少。
我们的研究结果表明，局部应用布比卡因+酮咯酸可能会减轻术后 1 小时的疼痛。此外，局部麻醉可能会减少术后阿片类药物的使用。然而，由于纳入研究的数量较少，局部麻醉在隆胸术中的临床获益仍需进一步证实。
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