From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey PA.
Department of General Surgery, Indiana University Health, Indianapolis, IN.
Ann Plast Surg. 2023 Jun 1;90(6S Suppl 5):S533-S537. doi: 10.1097/SAP.0000000000003521. Epub 2023 Mar 17.
With an increasing focus on multimodal pain control to reduce opioid requirements, regional and local anesthesia techniques have been investigated in bilateral reduction mammaplasty with variable results. The purpose of this study is to compare tumescent anesthesia with pectoral nerve block II (PECS II) in patients undergoing bilateral reduction mammaplasty with respect to postoperative pain and nausea, opioid consumption, length of stay, and cost.
A retrospective review of patients undergoing bilateral reduction mammaplasty for macromastia between November 2020 and December 2021 was performed. Demographic information, operative and anesthesia times, antiemetic and morphine equivalent requirements, postoperative numeric pain rating scales, and time until hospital discharge were compared between groups. χ2 and Fisher exact tests examined subgroup differences in categorical variables. Two-sample t test and Wilcoxon rank-sum test evaluated differences in continuous parametric and nonparametric variables, respectively.
Fifty-three patients underwent bilateral reduction mammaplasty by 3 surgeons, 71.7% (n = 38) with tumescent anesthesia infiltrated by the operating surgeon before the start of the procedure and 28.3% (n = 15) with bilateral PECS II blocks performed by anesthesia before the start of the procedure. There was no difference in age, body mass index, weight resected, intraoperative medication, or immediate postoperative complications. Postoperative pain scores and opioid requirements were similar between the 2 groups. Twenty-one percent (n = 8) of tumescent patients compared with 66.7% (n = 10) of block patients required 1 or more doses of postoperative antiemetics ( P = 0.002). Patients who received blocks spent longer in the postoperative recovery area (5.3 vs 7.1 hours, P < 0.01). However, this did not translate to a significant increase in overnight stays. The block group had significantly higher hospitalization cost by an average of $4000, driven by pharmacy and procedural cost ( P < 0.01).
In this cohort of multimodal perioperative pain-controlled reduction mammaplasty patients, tumescent anesthesia was associated with decreased antiemetic requirements, less time in recovery before discharge, and lower cost compared with PECS II blocks. Therefore, tumescent anesthesia may be favored over PECS II blocks when considering multimodal pain control strategies in reduction mammaplasty patients.
随着人们越来越关注多模式疼痛控制以减少阿片类药物的需求，区域和局部麻醉技术已被应用于双侧乳房缩小术，并取得了不同的结果。本研究旨在比较肿胀麻醉与胸肌神经阻滞 II 型（PECS II）在双侧乳房缩小术中的效果，比较术后疼痛、恶心、阿片类药物消耗、住院时间和成本。
回顾性分析 2020 年 11 月至 2021 年 12 月期间因巨乳症行双侧乳房缩小术的患者。比较两组患者的人口统计学资料、手术和麻醉时间、止吐药和吗啡等效物需求、术后数字疼痛评分量表以及出院时间。χ2 和 Fisher 确切检验分析了分类变量的亚组差异。两样本 t 检验和 Wilcoxon 秩和检验分别评估了连续参数和非参数变量的差异。
3 名外科医生为 53 名患者实施了双侧乳房缩小术，其中 71.7%（n=38）采用肿胀麻醉，由手术医生在手术开始前进行浸润，28.3%（n=15）采用双侧 PECS II 阻滞，由麻醉医生在手术开始前进行。两组患者的年龄、体重指数、切除体重、术中用药或术后即刻并发症无差异。两组患者术后疼痛评分和阿片类药物需求相似。肿胀麻醉组有 21%（n=8）的患者需要 1 次或多次术后止吐药治疗，而阻滞组有 66.7%（n=10）的患者需要（P=0.002）。接受阻滞的患者在术后恢复区的时间较长（5.3 小时 vs 7.1 小时，P<0.01）。然而，这并没有导致过夜停留时间的显著增加。阻滞组的住院费用显著增加，平均增加 4000 美元，主要是由于药房和手术费用（P<0.01）。
在本队列接受多模式围手术期疼痛控制的乳房缩小术患者中，肿胀麻醉与减少止吐药需求、出院前恢复时间缩短和成本降低相关，与 PECS II 阻滞相比。因此，在考虑乳房缩小术患者的多模式疼痛控制策略时，肿胀麻醉可能优于 PECS II 阻滞。
