无阿片类麻醉联合胸段神经阻滞对乳腺癌根治术后患者恢复质量的影响：一项随机对照试验。
Effect of opioid-free anesthesia combined with pectoral nerve block on the quality of recovery in patients after mastectomy: A randomized, controlled trial.
作者信息
Chen Jiawei, He Lewei, Shi Yuying, Jiao Jing, Huang Shaoqiang, Zhou Jianhua, Luo Qingyan
机构信息
Department of Anesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
出版信息
PLoS One. 2025 Apr 3;20(4):e0320592. doi: 10.1371/journal.pone.0320592. eCollection 2025.
OBJECTIVE
To evaluate the impact of opioid-free anesthesia (OFA) combined with regional blocks on the quality of recovery (QoR) in patients who underwent mastectomy.
METHODS
This randomized controlled trial involved 132 mastectomy patients who were randomized to receive either OFA combined with PECS block or opioid-based anesthesia (OBA) combined with PECS block. The QoR was assessed using the QoR-15 global score at 24 h post-surgery. Secondary outcomes included postoperative sufentanil consumption, incidence of postoperative nausea and vomiting (PONV), Numerical Rating Scale (NRS) scores at 1, 4, and 24 h, incidence of postoperative adverse events, extubation, incidence of severe bradycardia and intraoperative mean artrial pressure (MAP) and heart rate (HR) at after entering the operating room (T0, baseline value), after intubation (T1), after skin incision (T2), and after extubation (T3).
RESULTS
The QoR-15 global score at 24 h was not significantly different between groups (MD = -0.4, 95% CI [-3.8 to 4.7], P = 0.67). Postoperative sufentanil consumptions (P = 0.075), the incidence of PONV (P = 0.12), NRS scores at 1 h (P = 0.36), 4 h (P = 0.53), and 24 h (P = 0.02) were not significantly different. Incidence of adverse events (OR = 0, 95% CI [0 to 0.44], P = 0.0063) were lower in Group OFA than that in Group OBA. Extubation time was significantly longer in Group OFA than in Group OBA (MD = 15, 95%CI [10-18], P < 0.001). MAPs at T1 and T2 were significantly higher in Group OFA than in Group OBA (P < 0.0125), while MAP and HR at T3 were significantly lower in Group OFA than in Group OBA(P < 0.0125). Incidence of severe bradycardia were not significantly different (P = 0.67).
CONCLUSION
In conclusion, while OFA contributes to a reduction in adverse events, its integration with PECS blocks does not improve QoR or postoperative analgesia at 24 h post-mastectomy. Moreover, OFA was associated with a prolonged extubation time.
TRIAL REGISTRATION
chictr.org; registration number: ChiCTR2100043575.
目的
评估无阿片类药物麻醉（OFA）联合区域阻滞对接受乳房切除术患者恢复质量（QoR）的影响。
方法
这项随机对照试验纳入了132例乳房切除术患者，他们被随机分为接受OFA联合胸肌间神经阻滞（PECS阻滞）或基于阿片类药物的麻醉（OBA）联合PECS阻滞。术后24小时使用QoR-15整体评分评估恢复质量。次要结局包括术后舒芬太尼消耗量、术后恶心呕吐（PONV）发生率、术后1、4和24小时的数字评分量表（NRS）评分、术后不良事件发生率、拔管情况、严重心动过缓发生率以及进入手术室后（T0，基线值）、插管后（T1）、皮肤切开后（T2）和拔管后（T3）的术中平均动脉压（MAP）和心率（HR）。
结果
两组术后24小时的QoR-15整体评分无显著差异（MD = -0.4，95%CI [-3.8至4.7]，P = 0.67）。术后舒芬太尼消耗量（P = 0.075）、PONV发生率（P = 0.12）、术后1小时（P = 0.36）、4小时（P = 0.53）和24小时（P = 0.02）的NRS评分无显著差异。OFA组的不良事件发生率（OR = 0，95%CI [0至0.44]，P = 0.0063）低于OBA组。OFA组的拔管时间明显长于OBA组（MD = 15，95%CI [10 - 18]，P < 0.001）。OFA组在T1和T2时的MAP明显高于OBA组（P < 0.0125），而OFA组在T3时的MAP和HR明显低于OBA组（P < 0.0125）。严重心动过缓的发生率无显著差异（P = 0.67）。
结论
总之，虽然OFA有助于减少不良事件，但它与PECS阻滞联合使用并不能改善乳房切除术后24小时的恢复质量或术后镇痛效果。此外，OFA与延长的拔管时间有关。
试验注册
chictr.org；注册号：ChiCTR2100043575。
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