Zhang Tongtong, Feng Weifeng, Li Haoran, Lin Yan, Mu Dali
Department of Breast Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China.
Department of Cosmetic Surgery, Beijing Badachu Plastic Surgery, Fifth Medical Aesthetic Hospital, Building C3-C4, Starlight Vision Park, No.1 Hongye East Road, Daxing District, Beijing, 102600, China.
Plast Reconstr Surg. 2025 Jul 29. doi: 10.1097/PRS.0000000000012344.
Pain is a prominent symptom in prosthetic breast augmentation via axillary incision and persists throughout hospitalization. However, routine analgesia is not always effective for all patients. Duration of regional block with ropivacaine is also limited. The objective is to evaluate whether the combination of methylene blue and ropivacaine via serratus anterior plane block provides superior long-lasting analgesia compared to ropivacaine alone in prosthetic breast augmentation.
This double-blind, single-center, randomized controlled trial enrolled 72 female patients, who were randomly and equally assigned to the control group, the ropivacaine group and the ropivacaine + methylene blue group during surgery. A standard postoperative analgesic regimen was administered to all patients. The visual analogue scale (VAS) was employed to assess pain scores, which were observed and recorded at 6, 24, 48 and 72 hours postoperatively by two well-trained, independent investigators.
No statistically significant differences were observed in age (P = 0.200), BMI (P = 0.200), prosthesis brand (P = 0.764), size (P = 0.580) or type (P = 0.260) among the three groups. The study demonstrated that serratus anterior plane block significantly improves postoperative pain management within 24 hours. Furthermore, the ropivacaine + methylene blue group showed no advantages over ropivacaine group at 6 hours postoperatively, while it had a better VAS score than the ropivacaine group 24, 48 and 72 hours postoperatively, which were statistically significant differences (P < 0.05).
The analgesic effect of methylene blue and ropivacaine in serratus anterior plane block has a longer duration than ropivacaine alone in prosthetic breast augmentation.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
ChiCTR2500097610.
疼痛是经腋窝切口行假体隆胸术中的一个突出症状，且在整个住院期间持续存在。然而，常规镇痛并非对所有患者都有效。罗哌卡因区域阻滞的持续时间也有限。目的是评估在假体隆胸术中，与单独使用罗哌卡因相比，通过前锯肌平面阻滞联合亚甲蓝和罗哌卡因是否能提供更优的长效镇痛效果。
本双盲、单中心、随机对照试验纳入72例女性患者，在手术期间将她们随机且等分为对照组、罗哌卡因组和罗哌卡因+亚甲蓝组。所有患者均接受标准的术后镇痛方案。采用视觉模拟评分法（VAS）评估疼痛评分，由两名训练有素的独立研究者在术后6、24、48和72小时进行观察和记录。
三组患者在年龄（P = 0.200）、体重指数（P = 0.200）、假体品牌（P = 0.764）、尺寸（P = 0.580）或类型（P = 0.260）方面未观察到统计学显著差异。研究表明，前锯肌平面阻滞在24小时内可显著改善术后疼痛管理。此外，罗哌卡因+亚甲蓝组在术后6小时时并不优于罗哌卡因组，而在术后24、48和72小时时其VAS评分优于罗哌卡因组，差异具有统计学意义（P < 0.05）。
在假体隆胸术中，亚甲蓝和罗哌卡因在前锯肌平面阻滞中的镇痛效果持续时间比单独使用罗哌卡因更长。
临床问题/证据级别：治疗性，I级。
ChiCTR2500097610。
