Zhao Ying, Jin Weilin, Pan Peng, Feng Shuquan, Fu Danyun, Yao Junyan
Department of Anesthesiology, Kunshan Hospital of Traditional Chinese Medicine, No.189, Chaoyang road, Yushan District, Kunshan, 215300, Jiangsu, China.
Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100, Haining Road, Hong Kou District, Shanghai, 200080, China.
Perioper Med (Lond). 2022 Jul 27;11(1):39. doi: 10.1186/s13741-022-00270-3.
Modified radical mastectomy (MRM) is the most effective and common type of invasive surgery for breast cancer. However, it causes moderate to severe acute pain and even lasts for a long postoperative period. Transversus thoracic muscle plane-pectoral nerve block (TTP-PECS) is a novel and promising interfacial plane block which can provide analgesia for MRM while thoracic paravertebral nerve block (TPVB) is also widely used for this purpose. This study compared the postoperative analgesia between the ultrasound-guided TTP-PECS and TPVB in patients undergoing MRM.
In this randomized controlled trial, eighty female breast cancer patients undergoing unilateral MRM with sentinel lymph node dissection (SLND) and axillary dissection (ALND) were enrolled. Patients were randomized to receive either ultrasound-guided TTP-PECS (TTP-PECS group, n = 40) or TPVB (TPVB group, n = 40) with 0.5% ropivacaine 30 ml. Evaluated variables included 24 h postoperative total PCA fentanyl consumption, including PCA background consumption and PCA press consumption (per bolus dosage multiply by the effective pressing times), and intraoperative fentanyl consumption, as well as postoperative flurbiprofen axetil requirement, duration of analgesia, blocking area, pain intensity at rest and during activity, ability to reduce the inflammatory response, and the quality of recovery 40 (QoR-40) score of patients.
Compared with the TPVB, the main blocking area was T-T in the TTP-PECS group, which was more suitable for the MRM. TTP-PECS has a longer analgesia duration than TPVB; 24 h postoperative total PCA fentanyl consumption, especially the PCA press consumption, and the postoperative flurbiprofen axetil requirement were decreased in the TTP-PECS group than those in the TPVB group. Furthermore, the VAS scores at rest and during activity and inflammatory response were lower in the TTP-PECS group compared with the TPVB group at 12 h postoperatively. Finally, the total QoR-40 score, especially for the scores of pain; emotional state; and patient support were better in the TTP-PECS group.
Compared with the TPVB, TTP-PECS can provide better postoperative analgesia in patients undergoing MRM, simultaneously reduce the inflammatory response, and prompt early recovery. These results suggest that TTP-PECS is an attractive alternative to TPVB for postoperative analgesia of modified radical mastectomy.
改良根治性乳房切除术（MRM）是治疗乳腺癌最有效且常见的侵入性手术方式。然而，该手术会导致中度至重度急性疼痛，甚至在术后持续较长时间。胸横肌平面 - 胸肌神经阻滞（TTP - PECS）是一种新型且有前景的界面平面阻滞技术，可为MRM提供镇痛效果，而胸段椎旁神经阻滞（TPVB）也广泛用于此目的。本研究比较了超声引导下TTP - PECS和TPVB在接受MRM患者中的术后镇痛效果。
在这项随机对照试验中，纳入了80例接受单侧MRM并进行前哨淋巴结清扫（SLND）和腋窝淋巴结清扫（ALND）的女性乳腺癌患者。患者被随机分为接受超声引导下TTP - PECS组（TTP - PECS组，n = 40）或TPVB组（TPVB组，n = 40），注射0.5%罗哌卡因30 ml。评估变量包括术后24小时PCA芬太尼总消耗量，包括PCA背景消耗量和PCA按压消耗量（每次推注剂量乘以有效按压次数）、术中芬太尼消耗量、术后氟比洛芬酯需求量、镇痛持续时间、阻滞区域、静息和活动时的疼痛强度、减轻炎症反应的能力以及患者的恢复质量40（QoR - 40）评分。
与TPVB组相比，TTP - PECS组的主要阻滞区域为T - T，更适合MRM手术。TTP - PECS的镇痛持续时间比TPVB长；TTP - PECS组术后24小时PCA芬太尼总消耗量，尤其是PCA按压消耗量以及术后氟比洛芬酯需求量均低于TPVB组。此外，术后12小时TTP - PECS组静息和活动时的VAS评分以及炎症反应均低于TPVB组。最后，TTP - PECS组的QoR - 40总分，尤其是疼痛、情绪状态和患者支持方面的评分更高。
与TPVB相比，TTP - PECS可为接受MRM的患者提供更好的术后镇痛效果，同时减轻炎症反应并促进早期恢复。这些结果表明，TTP - PECS是改良根治性乳房切除术后镇痛替代TPVB的一种有吸引力的选择。
