Ajkay Nicolas, Bhutiani Neal, Clark Laura L, Holland Michelle, McMasters Kelly M, Egger Michael E
The Hiram C. Polk, Jr., MD Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, KY.
The Hiram C. Polk, Jr., MD Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, KY.
Surgery. 2025 Mar;179:108897. doi: 10.1016/j.surg.2024.08.055. Epub 2024 Oct 31.
Adequate postoperative pain control is essential after mastectomy. This study compares the influence of 2 regional analgesia techniques on length of stay and opioid use to systemic analgesia alone.
Patients treated with mastectomy from 2014 to 2020 were stratified according to perioperative analgesic modality (systemic analgesia versus thoracic epidural anesthesia or erector spinae plane block). Demographic, tumor, and treatment characteristics were compared. Outcome variables included postoperative anesthesia unit and hospital length of stay, postoperative day 1 and 2 discharge rates, and inpatient opioid use (in oral milligram morphine equivalents).
Of 316 patients, 171 received systemic analgesia, 72 thoracic epidural anesthesia, and 73 erector spinae plane block. On univariate analysis, there were significant differences in age, neoadjuvant chemotherapy, bilateral surgery, immediate reconstruction, and Her2 positivity rates. Thoracic epidural anesthesia had the longest hospital length of stay, and erector spinae plane block the shortest, compared with systemic analgesia (52.1 vs 28 vs 30.6 hours, P < .0001). Postoperative day 1 discharge was more likely with erector spinae plane block than systemic analgesia and less likely with thoracic epidural anesthesia (89% vs 68.4% vs 30.6%, P < .0001). Erector spinae plane block required significantly less milligram morphine equivalents than thoracic epidural anesthesia or systemic analgesia on postoperative day 1 (10 vs 18.75 vs 20 milligram morphine equivalents, P < .0009), but no differences on postoperative day 2 (23.5 vs 20 vs 25 milligram morphine equivalents, P = .84). Total hospital opioid use was significantly lower for erector spinae plane block than thoracic epidural anesthesia or systemic analgesia (24 vs 32.3 vs 32 milligram morphine equivalents, P = .024). On multivariate analysis, thoracic epidural anesthesia was associated with significantly longer length of stay, whereas neither thoracic epidural anesthesia nor erector spinae plane block was associated with decreased opioid use.
Regional analgesia is not significantly associated with decreased opioid use or hospital length of stay.
乳房切除术后充分的术后疼痛控制至关重要。本研究比较了两种区域镇痛技术与单纯全身镇痛相比对住院时间和阿片类药物使用的影响。
对2014年至2020年接受乳房切除术的患者，根据围手术期镇痛方式（全身镇痛与胸段硬膜外麻醉或竖脊肌平面阻滞）进行分层。比较人口统计学、肿瘤和治疗特征。结局变量包括术后麻醉恢复室和住院时间、术后第1天和第2天的出院率以及住院期间阿片类药物的使用量（以口服毫克吗啡当量计）。
316例患者中，171例接受全身镇痛，72例接受胸段硬膜外麻醉，73例接受竖脊肌平面阻滞。单因素分析显示，年龄、新辅助化疗、双侧手术、即刻重建和Her2阳性率存在显著差异。与全身镇痛相比，胸段硬膜外麻醉的住院时间最长，竖脊肌平面阻滞最短（52.1小时对28小时对30.6小时，P <.0001）。竖脊肌平面阻滞术后第1天出院的可能性高于全身镇痛，低于胸段硬膜外麻醉（89%对68.4%对30.6%，P <.0001）。竖脊肌平面阻滞术后第1天所需的毫克吗啡当量显著低于胸段硬膜外麻醉或全身镇痛（10毫克吗啡当量对18.75毫克吗啡当量对20毫克吗啡当量，P <.0009），但术后第2天无差异（23.5毫克吗啡当量对20毫克吗啡当量对25毫克吗啡当量，P =.84）。竖脊肌平面阻滞的住院期间总阿片类药物使用量显著低于胸段硬膜外麻醉或全身镇痛（24毫克吗啡当量对32.3毫克吗啡当量对32毫克吗啡当量，P =.024）。多因素分析显示，胸段硬膜外麻醉与住院时间显著延长相关，而胸段硬膜外麻醉和竖脊肌平面阻滞均与阿片类药物使用减少无关。
区域镇痛与阿片类药物使用减少或住院时间缩短无显著相关性。
