Lewis Holden, Evans J Holt, Mullen Michael, Gustetic Andrew, Kim Seiha, Lane Miles, Jablonski Rebecca
Medicine, Edward Via College of Osteopathic Medicine, Spartanburg, USA.
Anesthesiology, Spartanburg Regional Healthcare System, Spartanburg, USA.
Cureus. 2024 Nov 5;16(11):e73086. doi: 10.7759/cureus.73086. eCollection 2024 Nov.
Introduction Breast cancer is one of the most common female malignancies in the United States and often necessitates surgical interventions that carry a substantial risk of postoperative pain. Pectoral nerve blocks have emerged as a simpler alternative for providing regional perioperative analgesia to the chest wall in breast cancer surgery. This retrospective study evaluated the impact of implementing a novel regional anesthesia protocol centering on the use of pectoral nerve blocks for patients undergoing radical mastectomy at a small regional hospital in Spartanburg, South Carolina. Methods A retrospective study was conducted to examine the effects of peripheral nerve blocks, specifically pectoral nerve blocks, on intra- and postoperative milligram morphine equivalent consumption and postoperative length of stay for 168 mastectomy patients at Spartanburg Medical Center between June 2022 and June 2023. The association between anesthesia regimen received, length of stay, and perioperative milligram morphine equivalents consumed was examined using Wilcoxon rank sum testing. Results Patients who received pectoral nerve blocks (n = 23) demonstrated a 31.53% decrease in milligram morphine equivalent consumption in comparison to patients who received other types of peripheral nerve blocks within the same perioperative window. The length of stay for study patients who received pectoral nerve blocks (1.07 days) was grossly comparable to that for patients who received any other type of regional nerve block for their mastectomy over the course of the investigation (0.92 days). Conclusions For the provision of regional analgesia for mastectomy, pectoral nerve blocks were demonstrated to be non-inferior to other types of peripheral blocks traditionally used in this setting. After the change in protocol to pectoral nerve blocks in January 2023, mastectomy patients receiving pectoral nerve blocks required less perioperative pain medication, with no significant adverse impact on length of stay.
引言
乳腺癌是美国最常见的女性恶性肿瘤之一，通常需要进行手术干预，而手术干预存在术后疼痛的重大风险。胸神经阻滞已成为乳腺癌手术中为胸壁提供区域围手术期镇痛的一种更简单的替代方法。这项回顾性研究评估了在南卡罗来纳州斯巴达堡的一家小型地区医院，实施以胸神经阻滞为中心的新型区域麻醉方案对接受根治性乳房切除术患者的影响。
方法
进行一项回顾性研究，以检查2022年6月至2023年6月期间在斯巴达堡医疗中心接受乳房切除术的168例患者，外周神经阻滞，特别是胸神经阻滞，对术中及术后吗啡当量毫克消耗量和术后住院时间的影响。使用Wilcoxon秩和检验检查所接受的麻醉方案、住院时间和围手术期吗啡当量毫克消耗量之间的关联。
结果
与在同一围手术期接受其他类型外周神经阻滞的患者相比，接受胸神经阻滞的患者（n = 23）的吗啡当量毫克消耗量降低了31.53%。在研究过程中，接受胸神经阻滞的患者的住院时间（1.07天）与接受任何其他类型区域神经阻滞进行乳房切除术的患者的住院时间（0.92天）大致相当。
结论
对于乳房切除术的区域镇痛，胸神经阻滞被证明不劣于该情况下传统使用的其他类型外周阻滞。在2023年1月改为胸神经阻滞方案后，接受胸神经阻滞的乳房切除术患者围手术期所需的止痛药物较少，且对住院时间没有显著不利影响。
