Hoda Wasimul, Puri Sidharth, Garg Rakesh
Department of Anesthesiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
Department of Critical Care, Max, Dehradun, Uttarakhand, India.
Anesth Essays Res. 2022 Jan-Mar;16(1):172-176. doi: 10.4103/aer.aer_18_22. Epub 2022 Jul 18.
In early stages of breast cancer, breast conservation therapy (BCT) with lumpectomy and adjuvant irradiation is preferred. Accelerated partial breast irradiation (APBI) is considered as an alternative to whole breast irradiation. The reasons are it requires less number of irradiation fractions, shorter treatment time, and decreased size of irradiation. The procedure includes insertion of several brachycatheters, which is associated with significant pain in the postoperative period. We report case series of 8 patients of APBI where perioperative pain management was done using ultrasound (USG)-guided serratus anterior plane (SAP) block with catheter insertion. The catheter was placed between the serratus anterior muscle and external intercostal muscle. The drug used was 0.4 mL.kg of 0.375% Ropivacaine with a maximum value of 30 mL. On the day of the procedure, all patients were given two boluses of ropivacaine 20 mL each at an interval of 6 h. From the next day onward, they received ropivacaine boluses on demand basis when Numerical Rating Scale (NRS) was >4. There were no complications during the procedure. None of the patients required extra fentanyl boluses intraoperatively. One patient did not have an SAP catheter inserted during primary insertion, as she failed to give consent for block. On repositioning of catheters, she experienced severe pain with a NRS of 8/10. After obtaining proper consent, SAP catheter was inserted and she had NRS of 1/10 postoperatively. 2/8 patients received rescue analgesics in the form of diclofenac. 7/8 SAP catheters were removed on day 5. Only one SAP catheter was removed accidentally on day 3. It was concluded that USG-guided SAP catheters are a novel, safe, and effective regional anesthesia technique for perioperative pain management in breast cancer surgeries undergoing APBI.
在乳腺癌早期，保乳手术（BCT）联合肿块切除术及辅助放疗是首选治疗方式。加速部分乳腺照射（APBI）被视为全乳照射的替代方案。原因在于其所需照射次数更少、治疗时间更短且照射范围更小。该手术需插入多根近距离放疗导管，这在术后会带来明显疼痛。我们报告了8例接受APBI治疗患者的病例系列，术中采用超声（USG）引导的前锯肌平面（SAP）阻滞联合导管插入进行围手术期疼痛管理。导管置于前锯肌与肋间外肌之间。使用的药物为0.375%罗哌卡因，剂量为0.4 mL/kg，最大剂量为30 mL。手术当天，所有患者每隔6小时给予2次20 mL罗哌卡因推注。从次日起，当数字评分量表（NRS）>4时，根据需求给予罗哌卡因推注。手术过程中无并发症发生。术中无患者需要额外给予芬太尼推注。1例患者在初次插入时未插入SAP导管，因为她未同意进行阻滞。在重新放置导管时，她经历了严重疼痛，NRS评分为8/10。在获得适当同意后，插入了SAP导管，术后她的NRS评分为1/10。2/8的患者接受了双氯芬酸形式的解救镇痛药。7/8的SAP导管在第5天拔除。仅1根SAP导管在第3天意外拔除。结论是，USG引导的SAP导管是一种用于接受APBI的乳腺癌手术围手术期疼痛管理的新颖、安全且有效的区域麻醉技术。
