Uribe Alberto A, Weaver Tristan E, Echeverria-Villalobos Marco, Periel Luis, Pasek Joshua, Fiorda-Diaz Juan, Palettas Marilly, Skoracki Roman J, Poteet Stephen J, Heard Jarrett A
Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH, United States.
Department of Biomedical Informatics, The Ohio State University, Center of Biostatistics, Columbus, OH, United States.
Front Med (Lausanne). 2022 Aug 15;9:975080. doi: 10.3389/fmed.2022.975080. eCollection 2022.
Pectoralis nerve blocks (PECS) have been shown in numerous studies to be a safe and effective method to treat postoperative pain and reduce postoperative opioid consumption after breast surgery. However, there are few publications evaluating the PECS block effectiveness in conjunction with multimodal analgesia (MMA) in outpatient breast surgery. This retrospective study aims to evaluate the efficacy of PECS's blocks on perioperative pain management and opioid consumption.
We conducted a retrospective study to assess the efficacy of preoperative PECS block in addition to preoperative MMA (oral acetaminophen and/or gabapentin) in reducing opioid consumption in adult female subjects undergoing outpatient elective breast surgery between 2015 and 2020. A total of 228 subjects were included in the study and divided in two groups: PECS block group (received PECS block + MMA) and control Group (received only MMA). The primary outcome was to compare postoperative opioid consumption between both groups. The secondary outcome was intergroup comparisons of the following: postoperative nausea and vomiting (PONV), incidence of rescue antiemetic medication, PACU non-opioid analgesic medication required, length of PACU stay and the incidence of 30-day postoperative complications between both groups.
Two hundred and twenty-eight subjects ( = 228) were included in the study. A total of 174 subjects were allocated in the control group and 54 subjects were allocated in the PECS block group. Breast reduction and mastectomy/lumpectomy surgeries were the most commonly performed procedures (48% and 28%, respectively). The total amount of perioperative (intraoperative and PACU) MME was 27 [19, 38] in the control group and 28.5 [22, 38] in the PECS groups ( = 0.21). PACU opioid consumption was 14.3 [7, 24.5] MME for the control group and 17 [8, 23] MME (p = 0.732) for the PECS group. Lastly, the mean overall incidence of postsurgical complications at 30 days was 3% ( = 5), being wound infection, the only complication observed in the PECS groups ( = 2), and hematoma ( = 2) and wound dehiscence ( = 1) in the control group.
PECS block combined with MMA may not reduce intraoperative and/or PACU opioid consumption in patients undergoing outpatient elective breast surgery.
众多研究表明，胸肌神经阻滞（PECS）是一种安全有效的方法，可用于治疗乳房手术后的疼痛并减少术后阿片类药物的使用。然而，很少有出版物评估PECS阻滞联合多模式镇痛（MMA）在门诊乳房手术中的有效性。这项回顾性研究旨在评估PECS阻滞在围手术期疼痛管理和阿片类药物消耗方面的疗效。
我们进行了一项回顾性研究，以评估术前PECS阻滞联合术前MMA（口服对乙酰氨基酚和/或加巴喷丁）对2015年至2020年间接受门诊择期乳房手术的成年女性患者减少阿片类药物消耗的效果。共有228名受试者纳入研究并分为两组：PECS阻滞组（接受PECS阻滞+MMA）和对照组（仅接受MMA）。主要结局是比较两组术后阿片类药物的消耗量。次要结局是两组间以下指标的比较：术后恶心呕吐（PONV）、补救性抗呕吐药物的使用发生率、PACU所需的非阿片类镇痛药物、PACU停留时间以及两组术后30天并发症的发生率。
共有228名受试者纳入研究。对照组分配了174名受试者，PECS阻滞组分配了54名受试者。乳房缩小术和乳房切除术/肿块切除术是最常进行的手术（分别为48%和28%）。对照组围手术期（术中及PACU）吗啡毫克当量（MME）总量为27[19,38]，PECS组为28.5[22,38]（p=0.21）。对照组PACU阿片类药物消耗量为14.3[7,24.5]MME，PECS组为17[8,23]MME（p=0.732）。最后，术后30天手术并发症的平均总发生率为3%（n=5），其中伤口感染是PECS组观察到的唯一并发症（n=2），对照组有血肿（n=2）和伤口裂开（n=1）。
对于接受门诊择期乳房手术的患者，PECS阻滞联合MMA可能不会减少术中及/或PACU的阿片类药物消耗量。
