Stilo Francesco, Strumia Alessandro, Catanese Vincenzo, Montelione Nunzio, Tomaselli Eleonora, Pascarella Giuseppe, Costa Fabio, Ciolli Alessandro, Longo Ferdinando, Mattei Alessia, Schiavoni Lorenzo, Ruggiero Alessandro, Codispoti Francesco Alberto, Paolini Julia, Agrò Felice Eugenio, Spinelli Francesco, Carassiti Massimiliano, Cataldo Rita
Vascular Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy.
Research Unit of Vascular Surgery, Department of Medicine, University Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy.
J Clin Med. 2025 Jan 18;14(2):601. doi: 10.3390/jcm14020601.
Thoracic outlet syndrome (TOS) is an uncommon condition defined by the compression of neurovascular structures within the thoracic outlet. When conservative management strategies fail to alleviate symptoms, surgical decompression becomes necessary. The purpose of this study is to evaluate and compare the efficacy and safety of regional anesthesia (RA) using spontaneous breathing in contrast to general anesthesia (GA) for patients undergoing surgical intervention for TOS. We conducted a retrospective comparative study involving 68 patients who underwent trans-axillary first rib resection for TOS. The patient cohort was divided into two groups: 29 patients in the GA group and 39 patients in the RA group. The RA technique employed consisted of supraclavicular brachial plexus (SBP) and pectoral nerve (PECS II) blocks, accompanied by deep sedation. Key outcome measures such as pain scores, opioid consumption, and various perioperative parameters were systematically analyzed. Postoperative pain levels recorded in the recovery room were significantly lower in the RA group, with a median numerical rating scale (NRS) score of zero compared to two in the GA group ( = 0.0443). Additionally, both intraoperative and postoperative opioid consumption showed a marked reduction in the RA group, with -values of less than 0.001 and 0.0418, respectively. The RA approach was associated with shorter surgical durations ( = 0.0008), a decrease in the incidence of postoperative nausea and vomiting (PONV) ( = 0.0312), and a lower occurrence of intraoperative lung injuries ( < 0.0001). Furthermore, the length of hospital stay was significantly reduced for patients in the RA group. Although both groups reported low postoperative pain scores, the regional anesthesia approach exhibited distinct advantages in terms of opioid consumption, surgical duration, and overall perioperative outcomes. The utilization of SBP and PECS II blocks facilitated surgical procedures and mitigated complications, thereby positively influencing the postoperative recovery trajectory. Future prospective studies are essential to validate these findings further and to investigate long-term outcomes associated with the use of regional anesthesia in TOS surgery.
胸廓出口综合征（TOS）是一种罕见的疾病，其定义为胸廓出口内神经血管结构受压。当保守治疗策略无法缓解症状时，手术减压就变得必要。本研究的目的是评估和比较区域麻醉（RA）联合自主呼吸与全身麻醉（GA）用于接受TOS手术干预患者的疗效和安全性。我们进行了一项回顾性比较研究，纳入了68例行经腋路第一肋骨切除术治疗TOS的患者。患者队列分为两组：GA组29例患者和RA组39例患者。所采用的RA技术包括锁骨上臂丛神经（SBP）和胸神经（PECS II）阻滞，并辅以深度镇静。对疼痛评分、阿片类药物消耗量和各种围手术期参数等关键结局指标进行了系统分析。RA组在恢复室记录的术后疼痛水平显著较低，数字评分量表（NRS）中位数评分为零，而GA组为2（P = 0.0443）。此外，RA组术中及术后阿片类药物消耗量均显著减少，P值分别小于0.001和0.0418。RA方法与较短的手术时间相关（P = 0.0008），术后恶心呕吐（PONV）发生率降低（P = 0.0312），术中肺损伤发生率较低（P < 0.0001）。此外，RA组患者的住院时间显著缩短。虽然两组术后疼痛评分均较低，但区域麻醉方法在阿片类药物消耗量、手术时间和总体围手术期结局方面表现出明显优势。SBP和PECS II阻滞的应用促进了手术操作并减轻了并发症，从而对术后恢复轨迹产生了积极影响。未来的前瞻性研究对于进一步验证这些发现以及研究区域麻醉在TOS手术中的长期结局至关重要。
