Paliwal Naveen, Maurya Neetu, Suthar Om Prakash, Janweja Sarita
Department of Anesthesiology and Critical Care, Dr. S. N. Medical College, Jodhpur, Rajasthan, India.
Department of Anesthesiology, Government Medical College, Pali, Rajasthan, India.
J Anaesthesiol Clin Pharmacol. 2022 Oct-Dec;38(4):560-565. doi: 10.4103/joacp.JOACP_679_20. Epub 2022 Feb 4.
Breast surgery is associated with moderate-to-severe postoperative pain, nausea, and vomiting. For this, neuraxial anesthesia might be a better alternative to general anesthesia (GA), providing superior analgesia, with higher patient satisfaction and lesser incidence of nausea vomiting. This randomized-controlled open-label trial was done to compare segmental spinal and GA for breast cancer surgery.
The present study enrolled 56 female patients scheduled to undergo breast cancer surgery. They were randomly divided into two groups, group G (received standard GA) and group TS (received segmental thoracic spinal anesthesia with 0.5% isobaric levobupi vacaine at T5-T6 inter spaces). The primary objective of this study was patient satisfaction with the anesthetic technique, while secondary objectives were hemodynamic changes, perioperative complications, time of first rescue analgesic, total opioid consumption in first 24 h, and surgeon satisfaction score. Data were expressed as mean (SD) or number (%) as indicated and were compared using Chi-square, Fisher's exact, or Student's test as appropriate.
Patient in group TS had significantly higher satisfaction score median 5 (IQR 1) compared to patients in group G median 4 (IQR 3.5) ( = 0.0001). Nausea and vomiting were significantly higher in group G compared to group TS ( = 0.01). Mean time to rescue analgesia was 33.21 ± 7.48 min in group G as compared to 338.57 ± 40.70 in group TS and opioid consumption was also significantly lower in group TS (70.00 ± 27.38) as compared to group G (366.07 ± 59.40). There was no significant difference in hemodynamic parameters (except significantly lower heart rate at 15 min in group TS ( = 0.001) and surgeon satisfaction score between groups. Quality of postoperative analgesia was better in group TS.
Segmental thoracic spinal anesthesia technique provides better satisfaction with superior postoperative analgesia and fewer complications in patients undergoing breast cancer surgery compared to GA.
乳房手术会导致中度至重度的术后疼痛、恶心和呕吐。因此，神经轴索麻醉可能是全身麻醉（GA）的更好替代方案，它能提供更好的镇痛效果，患者满意度更高，恶心呕吐的发生率更低。本随机对照开放标签试验旨在比较节段性脊髓麻醉和全身麻醉用于乳腺癌手术的效果。
本研究纳入了56例计划接受乳腺癌手术的女性患者。她们被随机分为两组，G组（接受标准全身麻醉）和TS组（在T5 - T6间隙接受0.5%等比重左旋布比卡因的节段性胸段脊髓麻醉）。本研究的主要目标是患者对麻醉技术的满意度，次要目标是血流动力学变化、围手术期并发症、首次使用解救镇痛药的时间、术后24小时内的总阿片类药物消耗量以及外科医生满意度评分。数据以均值（标准差）或相应的数字（%）表示，并根据情况使用卡方检验、Fisher精确检验或学生检验进行比较。
与G组患者（中位数为4，四分位间距为3.5）相比，TS组患者的满意度评分中位数显著更高，为5（四分位间距为1）（P = 0.0001）。G组恶心和呕吐的发生率显著高于TS组（P = 0.01）。G组首次使用解救镇痛药的平均时间为33.21±7.48分钟，而TS组为338.57±40.70分钟，TS组的阿片类药物消耗量也显著低于G组（70.00±27.38），而G组为（366.07±59.40）。两组之间的血流动力学参数（除TS组在15分钟时心率显著较低外（P = 0.001））和外科医生满意度评分无显著差异。TS组术后镇痛质量更好。
与全身麻醉相比，节段性胸段脊髓麻醉技术在接受乳腺癌手术的患者中能提供更好的满意度、更优的术后镇痛效果且并发症更少。
