Wang Min, Niu Shu-Jie, Wu Jin, Zhong Yi-Wei, Lu Zi-Yun, Fu Qun, Li Bing-Bing
Department of Anesthesiology, Nanjing Drum Tower Hospital-Xuzhou Medical University, 321 Zhongshan Road, Nanjing, 210000, China.
Department of Anesthesiology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital-Nanjing University, Nanjing, China.
Pain Ther. 2025 May 29. doi: 10.1007/s40122-025-00740-8.
Breast cancer surgery is a common surgical procedure often associated with acute and chronic postoperative pain. As part of multimodal analgesia, the erector spinae plane block (ESPB) has been shown to effectively alleviate pain after breast cancer surgery. This study is the first to apply the posterior quadratus lumborum block (posterior QLB) for perioperative analgesia in breast cancer surgery. The aim of this research was to evaluate whether ESPB and QLB2 can relieve acute and chronic pain following breast cancer surgery.
A total of 120 female patients undergoing breast cancer surgery were randomly assigned to receive either ESPB, posterior QLB, or no intervention. All patients were administered sufentanil patient-controlled intravenous analgesia postoperatively. The primary outcome was the visual analog scale (VAS) pain scores recorded at 2, 6, 18, 24, and 48 h post-surgery under rest and motion conditions. Secondary outcomes included the incidence of moderate-to-severe pain within 24 and 48 h post-surgery, intraoperative fentanyl cumulative dosage, postoperative rescue analgesia, chronic pain incidence, recovery quality of life, and adverse events.
Compared to the group receiving conventional treatment (group C), the incidence of moderate-to-severe pain within 24 h post-surgery was significantly lower in both the group receiving ESPB (group E; 16.7% vs. 46.2%, P < 0.05) and the group receiving QLB (group Q; 20.5% vs. 46.2%, P < 0.05). Additionally, the proportion of patients requiring rescue analgesia was significantly reduced in both group E and group Q, compared to group C (group C vs. E vs. Q: 30.8% vs. 7.1% vs. 10.3%, P = 0.007; group C vs Q: 30.8% vs. 10.3%, P = 0.025; group C vs. E: 30.8% vs 7.1%, P = 0.006; group Q vs. E: 10.3% vs. 7.1%, P = 0.141). At 3 months post-surgery, group Q had a significantly lower incidence of chronic pain compared to both group C (19.5% vs. 71.8%, P < 0.05) and group E (19.5% vs. 57.1%, P < 0.05). No significant differences were observed between the groups in terms of VAS scores at 2, 6, 18, 24, or 48 h, intraoperative fentanyl consumption, postoperative nausea and vomiting, time to first mobilization, time to first oral intake, the length of hospital stay, or Quality of Recovery-15 Items (QoR-15) scores at 3 months post-surgery (all P > 0.05).
Compared with conventional intravenous analgesia, the combination of ultrasound-guided ESPB and posterior QLB significantly reduces the incidence of moderate-to-severe pain and the need for rescue analgesia within 24 h post-surgery. Furthermore, a single posterior QLB significantly reduces the incidence of chronic pain at 3 months post-surgery in patients with breast cancer.
Clinical trial number: ChiCTR2000041471.
乳腺癌手术是一种常见的外科手术，常伴有急性和慢性术后疼痛。作为多模式镇痛的一部分，竖脊肌平面阻滞（ESPB）已被证明可有效减轻乳腺癌手术后的疼痛。本研究首次将腰方肌后阻滞（QLB2）应用于乳腺癌手术的围手术期镇痛。本研究的目的是评估ESPB和QLB2能否缓解乳腺癌手术后的急性和慢性疼痛。
共有120例接受乳腺癌手术的女性患者被随机分配接受ESPB、QLB2或不进行干预。所有患者术后均接受舒芬太尼患者自控静脉镇痛。主要结局是在术后2、6、18、24和48小时在静息和活动状态下记录的视觉模拟量表（VAS）疼痛评分。次要结局包括术后24和48小时内中重度疼痛的发生率、术中芬太尼累积剂量、术后补救镇痛、慢性疼痛发生率、恢复生活质量和不良事件。
与接受传统治疗的组（C组）相比，接受ESPB的组（E组）和接受QLB2的组（Q组）术后24小时内中重度疼痛的发生率均显著降低（E组：16.7%对46.2%，P<0.05；Q组：20.5%对46.2%，P<0.05）。此外，与C组相比，E组和Q组需要补救镇痛的患者比例均显著降低（C组对E组对Q组：30.8%对7.1%对10.3%，P=0.007；C组对Q组：30.8%对10.3%，P=0.025；C组对E组：30.8%对7.1%，P=0.006；Q组对E组：10.3%对7.1%，P=0.141）。术后3个月，Q组慢性疼痛的发生率显著低于C组（19.5%对71.8%，P<0.05）和E组（19.5%对57.1%，P<0.05）。在术后2、6、18、24或48小时的VAS评分、术中芬太尼消耗量、术后恶心呕吐、首次活动时间、首次经口进食时间、住院时间或术后3个月的恢复质量-15项（QoR-15）评分方面，各组之间均未观察到显著差异（所有P>0.05）。
与传统静脉镇痛相比，超声引导下的ESPB与QLB2联合使用可显著降低术后24小时内中重度疼痛的发生率和补救镇痛的需求。此外，单次QLB2可显著降低乳腺癌患者术后3个月慢性疼痛的发生率。
临床试验编号：ChiCTR2000041471。
