Ditlev Martine, Loentoft Erik, Hölmich Lisbet R
Plastic Surgery Clinic, Erik Loentoft, Odense, Denmark.
Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
J Plast Surg Hand Surg. 2023 Feb-Dec;57(1-6):271-278. doi: 10.1080/2000656X.2022.2069789. Epub 2022 May 5.
This study of breast augmentations performed under local anesthesia with intercostal blocks and light sedation describes the outcomes and evaluates benefits and complications.
From December 2005 until August 2019, 335 women consecutively underwent bilateral breast augmentation procedures. The anesthetic protocol consisted of an initial intravenous bolus of 1 mg midazolam and 0.25 mg alfentanil preoperatively. In 2017, this was changed to 2-4 mg midazolam intramuscularly, 1 mg midazolam intravenously, and 2.5 µg sufentanil intravenously. Intercostal blocks were injected at the midaxillary line into the intercostal spaces two to seven. The operating field was infiltrated with tumescent local anesthesia. Retrospective data extraction from patients' medical charts was done, registering demographics, dosage of anesthesia, surgical characteristics, complications, and reoperation rates.
Two hundred and eighty-one women underwent primary augmentation and 54 had implant replacement. The most common complications included suboptimal cosmetic results, asymmetry, and healing-related problems. The overall rate of reoperation was 16.1% within an average follow-up period of 2 years, ranging from 0 to 12.5 years. The majority of the reoperations were due to cosmetic reasons. The change in anesthetic regime was associated with a significantly ( < 0.0001) decreased need for supplementary medication with no increased risk of complications.
Breast augmentations in local anesthesia with intercostal blocks and light sedation can be performed safely and can serve as an alternative to procedures in general anesthesia.
本研究描述了在肋间阻滞和轻度镇静下进行局部麻醉的隆胸手术的结果，并评估了其益处和并发症。
从2005年12月至2019年8月，335名女性连续接受了双侧隆胸手术。麻醉方案包括术前静脉推注1毫克咪达唑仑和0.25毫克阿芬太尼。2017年，改为术前肌内注射2 - 4毫克咪达唑仑、静脉注射1毫克咪达唑仑和静脉注射2.5微克舒芬太尼。在腋中线向第二至七肋间间隙注射肋间阻滞。手术区域用肿胀局部麻醉浸润。从患者病历中进行回顾性数据提取，记录人口统计学资料、麻醉剂量、手术特征、并发症和再次手术率。
281名女性接受了初次隆胸手术，54名进行了植入物置换。最常见的并发症包括美容效果欠佳、不对称和愈合相关问题。在平均2年的随访期内（随访期为0至12.5年），总体再次手术率为16.1%。大多数再次手术是出于美容原因。麻醉方案的改变与补充药物需求显著减少（<0.0001）相关，且并发症风险未增加。
在肋间阻滞和轻度镇静下进行局部麻醉的隆胸手术可以安全进行，可作为全身麻醉手术的替代方案。
