Coveney E, Weltz C R, Greengrass R, Iglehart J D, Leight G S, Steele S M, Lyerly H K
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Ann Surg. 1998 Apr;227(4):496-501. doi: 10.1097/00000658-199804000-00008.
To assess safety and efficacy of the regional anesthetic technique paravertebral block for operative treatment of breast cancer, and to compare postoperative pain, nausea, vomiting, and length of hospital stay in patients undergoing breast surgery using paravertebral block and general anesthesia.
General anesthesia is currently the standard technique used for surgical treatment of breast cancer. Increasing hospital costs have focused attention on reducing the length of hospital stay for these patients. However, the side effects and complications of general anesthesia preclude ambulatory surgery for most patients undergoing breast surgery. In April 1994, the authors initiated the use of paravertebral block anesthesia for patients undergoing primary breast cancer surgery. A review of our early experience revealed that this regional anesthetic technique enables effective anesthesia for operative procedures of the breast and axilla, reduces postoperative nausea and vomiting, and provides prolonged postoperative sensory block that minimizes narcotic requirements.
A retrospective analysis of 145 consecutive patients undergoing 156 breast cancer operations using paravertebral block and 100 patients undergoing general anesthesia during a 2-year period was performed. Anesthetic effectiveness and complications, inpatient experience with postoperative pain, nausea, vomiting, and length of stay were measured.
Surgery was successfully completed in 85% of the cases attempted by using paravertebral block alone, and in 91% of the cases, surgery was completed by using paravertebral block supplemented with local anesthetic. There was a 2.6% incidence of complications associated with block placement. Twenty percent of patients in the paravertebral group required medication for nausea and vomiting during their hospital stay compared with 39% in the general anesthesia group. Narcotic analgesia was required in 98% of general anesthesia patients, as opposed to 25% of patients undergoing paravertebral block. Ninety-six percent of patients having paravertebral block anesthesia were discharged within the day of surgery, compared with 76% of patients who had a general anesthetic.
Paravertebral block can be used to perform major operations for breast cancer with minimal complications and a low rate of conversion to general anesthesia. Paravertebral block markedly improves the quality of recovery after breast cancer surgery and provides the patient with the option of ambulatory discharge.
评估椎旁阻滞区域麻醉技术用于乳腺癌手术治疗的安全性和有效性，并比较采用椎旁阻滞和全身麻醉的乳腺癌手术患者术后疼痛、恶心、呕吐及住院时间。
全身麻醉是目前用于乳腺癌手术治疗的标准技术。不断增加的医院成本使人们将注意力集中在缩短这些患者的住院时间上。然而，全身麻醉的副作用和并发症使大多数接受乳腺癌手术的患者无法进行门诊手术。1994年4月，作者开始对接受原发性乳腺癌手术的患者使用椎旁阻滞麻醉。对我们早期经验的回顾显示，这种区域麻醉技术能够为乳房和腋窝手术提供有效的麻醉，减少术后恶心和呕吐，并提供延长的术后感觉阻滞，从而将麻醉剂需求降至最低。
对连续2年期间145例接受156次使用椎旁阻滞的乳腺癌手术患者和100例接受全身麻醉患者进行回顾性分析。测量麻醉效果和并发症、患者术后疼痛、恶心、呕吐及住院时间的情况。
仅使用椎旁阻滞的情况下，85%的尝试手术病例成功完成，在91%的病例中，使用椎旁阻滞并辅以局部麻醉完成了手术。与阻滞置管相关的并发症发生率为2.6%。椎旁阻滞组20%的患者在住院期间需要使用药物治疗恶心和呕吐，而全身麻醉组为39%。98%的全身麻醉患者需要使用麻醉性镇痛药，而接受椎旁阻滞的患者为25%。接受椎旁阻滞麻醉的患者中96%在手术当天出院，而接受全身麻醉的患者为76%。
椎旁阻滞可用于进行乳腺癌大手术，并发症最少，转为全身麻醉的比例低。椎旁阻滞显著提高了乳腺癌手术后的恢复质量，并为患者提供了门诊出院的选择。
