Mohan Srivarshini Cherukupalli, Siegel Emily, Tran Hai, Ozcan Lerna, Alban Rodrigo, Shariff Sashah, Mirocha James, Chung Alice, Giuliano Armando, Dang Catherine, Anand Kapil, Shane Rita, Amersi Farin
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Pharmacy Services, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Am J Surg. 2022 Sep;224(3):938-942. doi: 10.1016/j.amjsurg.2022.04.021. Epub 2022 Apr 22.
Inadequate pain control frequently extends length of stay (LOS) and costs for patients undergoing mastectomy with implant-based reconstruction (IBR). We sought to examine the effects of Paravertebral blocks (PVB) and liposomal bupivacaine (LB) and compare LOS, pain scores and costs of hospitalization.
Prospective database review of patients undergoing mastectomy with IBR was performed.
541 patients were identified. 51/491 (9.4%) received PVB and 50 (9.2%) received LB. LOS in the PVB group was significantly less than that of the no block (NB) group (1 [1-2] days PVB vs 3 [2-4] days NB (p < 0.0001), but was not different from the LB group (1 [1-2] days LB, p = 0.23). PVB patients had lower PACU pain scores compared to NB patients (3.2 ± 2.9 PVB vs 5.7 ± 2.6 NB, p < 0.0001), but similar PACU pain scores to LB patients (4.1 ± 2.3). Patients who received PVB had higher total costs compared to NB patients ($27148±$7053 PVB vs $23113 ± 6860 NB, p = 0.003) but similar to LB patients ($26183 ± $3761).
PVB and LB are associated with shorter LOS and lower pain scores compared to NB.
接受乳房切除术和植入物重建（IBR）的患者，疼痛控制不足常常会延长住院时间（LOS）和增加住院费用。我们旨在探讨椎旁阻滞（PVB）和包载布比卡因的脂质体（LB）的效果，并比较 LOS、疼痛评分和住院费用。
对接受 IBR 乳房切除术的患者进行前瞻性数据库回顾。
共确定了 541 名患者。51/491（9.4%）名患者接受了 PVB，50 名（9.2%）患者接受了 LB。PVB 组的 LOS 明显短于无阻滞（NB）组（1 [1-2]天 PVB 与 3 [2-4]天 NB（p<0.0001），但与 LB 组无差异（1 [1-2]天 LB，p=0.23）。与 NB 患者相比，PVB 患者 PACU 疼痛评分较低（3.2±2.9 PVB 与 5.7±2.6 NB，p<0.0001），但与 LB 患者相似（4.1±2.3）。与 NB 患者相比，接受 PVB 的患者总费用较高（27148±7053 PVB 与 23113±6860 NB，p=0.003），但与 LB 患者相似（26183±3761）。
与 NB 相比，PVB 和 LB 与较短的 LOS 和较低的疼痛评分相关。
