Prospective double blind randomized placebo-controlled clinical trial of the pectoral nerves (Pecs) block type II
Prospective double blind randomized placebo-controlled clinical trial of the pectoral nerves (Pecs) block type II
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DOI：
10.1016/j.jclinane.2017.03.054
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发表时间：
2017-08-01
影响因子：
6.7
通讯作者：
Van Houwe, Patrick
中科院分区：
文献类型：
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作者：
Versyck, Barbara;van Geffen, Geert-Jan;Van Houwe, Patrick
研究目的：本临床试验的目的是测试的假设是否增加胸神经（佩奇）块II型麻醉程序减少阿片类药物的消费过程中和乳腺surgery.Design：一个前瞻性随机双盲安慰剂对照研究。患者：140例接受乳房切除术或肿瘤切除术伴前哨淋巴结或腋窝淋巴结清扫术的1-3期乳腺癌患者。干预措施：患者随机接受0.25%左旋布比卡因佩奇阻滞（n = 70）或生理盐水安慰剂阻滞（n = 70）。测量：在麻醉后监护室停留时间（PAW）内，每15分钟通过数字评定量表（NRS）疼痛评分评估疼痛水平，在病房的前24小时内每隔2小时一次，在接下来的24小时内每隔4小时一次。在整个住院期间记录术中和术后阿片类药物的消耗。出院后采用10分制量表评价患者满意度。主要结果：佩奇组和安慰剂组术中舒芬太尼需求量相当（8.0 +/- 3.5 μ g和7.8 +/- 3.0 μ g，P= 0.730）。在PACU期间，佩奇组患者的疼痛明显少于对照组患者（P = 0.048）。此外，与对照组患者相比，佩奇组患者需要的术后阿片类药物显著更少（9.16 +/- 10.15 mg和14.97 +/- 14.38 mg吗啡当量，P = 0.037），并且需要的术后阿片类药物给药干预显著更少（P = 0.045）。两个患者组对他们的管理非常满意（10分制量表上的9.6 +/- 0.6和9.1 +/- 1.8，P = 0.211）。结论：佩奇阻滞减少了接受乳房手术的患者在PACU停留时间内的术后阿片类药物消耗。(C)2017爱思唯尔公司All rights reserved.
Study objective: The aim of this clinical trial was to test the hypothesis whether adding the pectoral nerves (Pecs) block type II to the anesthetic procedure reduces opioid consumption during and after breast surgery.Design: A prospective randomized double blind placebo-controlled study.Setting: A secondary hospital. Patients: 140 breast cancer stage 1-3 patients undergoing mastectomy or tumorectomy with sentinel node or axillary node dissection.Interventions: Patients were randomized to receive either a Pecs block with levobupivacaine 0.25% (n = 70) or placebo block with saline (n = 70).Measurements: The pain levels were evaluated by Numeric Rating Scale (NRS) pain scores at 15-minute intervals during the post anesthesia care unit stay time (PAW), at 2-hour intervals for the first 24 h on the ward and at 4 hour intervals for the next 24 h. Intraoperative and postoperative opioid consumption were recorded during the full stay. Patient satisfaction was evaluated upon discharge using a 10-point scale.Main results: Intraoperative sufentanil requirements were comparable for the Pecs and placebo group (8.0 +/- 3.5 mu g and 7.8 +/- 3.0 mu g, P= 0.730). Patients in the Pecs group experienced significantly less pain than patients in the control group (P = 0.048) during their PACU stay. Furthermore, patients in the Pecs group required significant less postoperative opioids (9.16 +/- 10.15 mg and 14.97 +/- 14.38 mg morphine equivalent, P = 0.037) and required significant fewer postsurgical opioid administration interventions than patients in the control group (P = 0.045). Both patient-groups were very satisfied about their management (9.6 +/- 0.6 and 9.1 +/- 1.8 on a 10-point scale, P = 0.211).Conclusions: The Pecs block reduces postsurgical opioid consumption during the PACU stay time for patients undergoing breast surgery. (C) 2017 Elsevier Inc. All rights reserved.