From the Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Östersund) (HA, JJ), the Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Sunderbyn) (DW, TM), and the Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden (MH).
Eur J Anaesthesiol. 2023 Sep 1;40(9):636-642. doi: 10.1097/EJA.0000000000001795. Epub 2023 Jan 12.
Surgery for breast cancer is common, and intravenous opioids are often used to control postoperative pain. Recently, pectoralis-2 (PECS-2) block has emerged as a promising regional anaesthetic alternative. With nomenclature recently proposed, this block is termed combined PSP/IPP-block (pectoserratus plane block/interpectoral plane block).
We aimed to compare the need for postoperative rescue morphine between the intervention group that received a pre-operative combined PSP/IPP-block and a control group that received peri-operative long-acting opioids for postoperative analgesia.
A randomised controlled study.
Operating theatres of two Swedish hospitals. The patients were recruited between May 2017 and October 2020.
Among the 199 women scheduled to undergo breast cancer surgery (sector resection or radical mastectomy) who were enrolled in the study, 185 were available for follow up.
All patients received general anaesthesia. The intervention group received a combined PSP/IPP-block before surgery. The control group received intravenous morphine 30 min before emergence from anaesthesia.
The primary endpoint was the cumulative need for intravenous rescue morphine to reach a predefined level of pain control (visual analogue scale score <40 mm) during the first 48 h after surgery.
Data from 92 and 93 patients in the intervention and control groups, respectively, were analysed. The amount of rescue morphine administered in the 48 h after surgery was significantly lower in the intervention group than in the control group (median: 2.25 vs 3.0 mg, P = 0.021). The first measured pain score was lower in the intervention group than in the control group (35 vs. 40 mm, P = 0.035). There was no significant difference in the incidence of nausea between the groups (8.7 vs. 12.9%, P = 0.357).
The use of a combined PSP/IPP-block block before breast cancer surgery reduces the need for postoperative rescue morphine, even when compared with the use of intra-operative morphine.
Clinicaltrials.gov identifier: NCT03117894.
乳腺癌手术较为常见，通常采用静脉注射阿片类药物来控制术后疼痛。最近，胸大肌 2 （PECS-2）阻滞作为一种有前途的区域麻醉替代方法出现。随着最近提出的命名法，该阻滞被称为联合 PSP/IPP 阻滞（胸肌筋膜平面阻滞/胸肌间平面阻滞）。
我们旨在比较接受术前联合 PSP/IPP 阻滞的干预组与接受围手术期长效阿片类药物用于术后镇痛的对照组之间，术后需要解救性吗啡的情况。
随机对照研究。
在两家瑞典医院的手术室进行。患者于 2017 年 5 月至 2020 年 10 月期间入组。
在计划接受乳腺癌手术（扇形切除术或根治性乳房切除术）的 199 名女性中，有 185 名患者可进行随访。
所有患者均接受全身麻醉。干预组在手术前接受联合 PSP/IPP 阻滞。对照组在麻醉苏醒前 30 分钟静脉注射吗啡。
主要终点是在术后 48 小时内达到预先设定的疼痛控制水平（视觉模拟评分 <40mm）所需的静脉内解救性吗啡的累积需求。
分别对 92 名和 93 名干预组和对照组患者的数据进行了分析。与对照组相比，干预组术后 48 小时内使用的解救性吗啡量明显较低（中位数：2.25mg 比 3.0mg，P =0.021）。干预组首次测量的疼痛评分低于对照组（35mm 比 40mm，P =0.035）。两组恶心发生率无显著差异（8.7%比 12.9%，P =0.357）。
乳腺癌手术前使用联合 PSP/IPP 阻滞可减少术后解救性吗啡的需求，甚至与术中使用吗啡相比也是如此。
Clinicaltrials.gov 标识符：NCT03117894。
