Swisher Matthew W, Nguyen Austin T, Becker Miriam, Sztain Jacklynn F, Abramson Wendy B, Tsuda Paige S, Alexander Brenton S, Reid Chris M, Said Engy T
Aesthet Surg J. 2025 May 15;45(6):605-610. doi: 10.1093/asj/sjaf043.
Breast reconstruction with abdominally based free flaps can be associated with more significant acute pain and longer hospital stays than implant-based techniques. As new pain management strategies are developed, there have not been any studies conducted to analyze the analgesic effects of intrathecal morphine (ITM) for patients undergoing abdominally based free flap reconstruction.
The primary outcome analyzed in this retrospective study was opioid consumption, which was measured from the postoperative anesthesia care unit (PACU) through postoperative day (POD) 2. Secondary outcomes of the study analyzed included factors such as pain scores, hospital length of stay (LOS), and adverse effects.
Fifty-one patients presented for breast reconstruction with abdominally based free flaps and received ITM for postoperative analgesia. Results obtained were compared with a cohort that included an equal number of patients who received paravertebral nerve blocks (PVBs).
Results showed that patients who received ITM displayed a lower median consumption in the PACU (0 mg vs 12.5 mg MEQ; P = .009), from PACU to POD 1 (0 mg vs 7.5 mg MEQ; P = .046), and POD 1 to POD 2 (7.5 mg vs 30 mg MEQ; P = .002) when compared with those who received PVBs. Those who received ITM also had lower median pain scores in the PACU and from PACU to POD 1 and a decreased LOS. There were similar rates of adverse events.
ITM improves postoperative analgesia after abdominally based free flaps when compared to PVBs and may facilitate recovery and earlier discharge.
与基于植入物的技术相比，采用腹部游离皮瓣进行乳房重建可能会伴有更严重的急性疼痛和更长的住院时间。随着新的疼痛管理策略的发展，尚未有研究分析鞘内注射吗啡（ITM）对接受腹部游离皮瓣重建患者的镇痛效果。
本回顾性研究分析的主要结局是阿片类药物的消耗量，从术后麻醉恢复室（PACU）至术后第2天（POD 2）进行测量。该研究分析的次要结局包括疼痛评分、住院时间（LOS）和不良反应等因素。
51例患者采用腹部游离皮瓣进行乳房重建，并接受ITM用于术后镇痛。将所得结果与一个包含同等数量接受椎旁神经阻滞（PVBs）患者的队列进行比较。
结果显示，与接受PVBs的患者相比，接受ITM的患者在PACU中的阿片类药物消耗量中位数较低（0毫克 vs 12.5毫克MEQ；P = 0.009），从PACU至POD 1时较低（0毫克 vs 7.5毫克MEQ；P = 0.046），以及在POD 1至POD 2时较低（7.5毫克 vs 30毫克MEQ；P = 0.002）。接受ITM的患者在PACU以及从PACU至POD 1时的疼痛评分中位数也较低，且住院时间缩短。不良事件发生率相似。
与PVBs相比，ITM可改善腹部游离皮瓣术后的镇痛效果，并可能促进恢复和提前出院。
