Breast Unit, Ospedale Unico Plurisede ASL VCO sedi di Verbania e Domodossola, Verbania, Italy.
Anaesthesia and Intensive Care, Ospedale Unico Plurisede ASL VCO sedi di Verbania e Domodossola, Domodossola, Italy.
Updates Surg. 2023 Aug;75(5):1297-1303. doi: 10.1007/s13304-023-01517-4. Epub 2023 Apr 24.
Strategies to reduce the postoperative pain in patients undergoing breast cancer surgery include the use of Interpectoral (PECs) block, first described by Blanco in 2011, but its feasibility and efficacy in everyday clinical practice has been debated. The aim of the study was to evaluate the routine feasibility and effectiveness of PECs block added to general anesthesia to reduce postoperative pain and opioids consumption in the Breast Unit's patients. From June to December 2021 all patients undergoing surgery were included to receive PECs1 block before general anesthesia; clinical and outcome data were prospectively collected. Fifty-eight out of 61 patients undergoing major or minor procedures were enrolled. The average time of block execution was 93.56 s (SD 42.45), with only one minor complication reported. Very low doses of intra and postoperative opioids consumption were reported, regardless of the type of surgery. The pain NRS resulted under the median value of 1 point [IQR 3] in the early postoperative period to 0 at 24-48 h, with beneficial effects lasting at least for two weeks, since no opioids consumption in the postoperative period had been reported, only 31% of patients required paracetamol with a dosage of 0.34 g (SD 0.548); comparison between type of surgery and different regimens of general anesthesia were reported. Routine use of PECs block, in addition to general anesthesia, was found to be safe, feasible and effective, resulting in low intraoperative opioids consumption, very low postoperative pain and analgesic requirement, with effects lasting up to two weeks after surgery.
用于减少乳腺癌手术后患者疼痛的策略包括采用胸肌间阻滞(Interpectoral,PECs),这是 Blanco 于 2011 年首次描述的方法,但在日常临床实践中其可行性和效果一直存在争议。本研究旨在评估 PECs 阻滞联合全身麻醉用于减少乳房外科患者术后疼痛和阿片类药物消耗的常规可行性和效果。2021 年 6 月至 12 月,所有接受手术的患者均在全身麻醉前接受 PECs1 阻滞;前瞻性收集临床和结局数据。58 例接受大手术或小手术的患者入组。阻滞执行的平均时间为 93.56 秒(标准差 42.45),仅报告了 1 例轻微并发症。无论手术类型如何,均报告了非常低剂量的术中及术后阿片类药物消耗。术后早期疼痛 NRS 评分中位数为 1 分[四分位数间距(IQR)3],24-48 小时降至 0 分,至少持续两周的有益效果,因为术后无阿片类药物消耗,仅 31%的患者需要剂量为 0.34g(标准差 0.548)的扑热息痛;报告了手术类型和不同全身麻醉方案之间的比较。发现 PECs 阻滞常规联合全身麻醉是安全、可行和有效的,可降低术中阿片类药物消耗,术后疼痛和镇痛需求非常低,术后 2 周内仍有效果。