Weltz C R, Greengrass R A, Lyerly H K
Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Ann Surg. 1995 Jul;222(1):19-26. doi: 10.1097/00000658-199507000-00004.
The authors describe an initial experience using paravertebral block for ambulatory or short-stay operations for breast cancer.
Rising hospital costs have focused attention on limiting the length of stay for patients undergoing surgical treatment of breast cancer. Thus far, ambulatory surgery has been limited by side effects and complications of general anesthesia. Paravertebral block offers the potential benefit of effective analgesia, with limited postoperative nausea and vomiting.
The medical records of the first 15 patients with breast cancer who underwent 16 major operations for the treatment of breast cancer using paravertebral block were reviewed. Patients were either discharged directly from the recovery room or after overnight hospital admission. The effectiveness of anesthesia, surgical outcome, patient satisfaction, and hospital costs are reviewed.
Paravertebral block achieved effective anesthesia for cancer operations of the breast and axilla; conversion to general anesthesia or supplementation with local anesthesia was not required. There was one postoperative hemorrhage, there were two seromas, and there was one superficial wound infection. Sensory block persisted for an average of 23 hours. Postoperative pain was effectively controlled, in fact, nine patients required no postoperative narcotic for pain control. Nausea and vomiting transiently afflicted three patients and prompted overnight observation in one patient originally scheduled for immediate discharge. Fourteen patients (93%) rated their experience as "very satisfactory."
Breast operations for the surgical management of breast cancer using paravertebral block can be performed safely, with great patient satisfaction, and with potential for significant cost savings.
作者描述了在乳腺癌门诊或短期住院手术中使用椎旁阻滞的初步经验。
不断上涨的医院成本促使人们关注限制乳腺癌手术患者的住院时间。到目前为止，门诊手术一直受到全身麻醉副作用和并发症的限制。椎旁阻滞具有有效镇痛的潜在益处，术后恶心和呕吐较少。
回顾了首批15例接受16次乳腺癌大手术且采用椎旁阻滞的患者的病历。患者要么直接从恢复室出院，要么在入院过夜后出院。对麻醉效果、手术结果、患者满意度和医院成本进行了评估。
椎旁阻滞对乳腺癌和腋窝癌手术实现了有效的麻醉；无需转为全身麻醉或补充局部麻醉。术后有1例出血、2例血清肿和1例浅表伤口感染。感觉阻滞平均持续23小时。术后疼痛得到有效控制，事实上，9例患者术后无需使用麻醉剂控制疼痛。恶心和呕吐短暂困扰了3例患者，其中1例原计划立即出院的患者因此需要过夜观察。14例患者（93%）对其体验评价为“非常满意”。
使用椎旁阻滞进行乳腺癌手术管理的乳房手术可以安全进行，患者满意度高，且有可能显著节省成本。
