Horner Syndrome Following Intercostal Nerve Block Via an Anterolateral Approach in Breast Lumpectomy: A Prospective Nested Case-control Study.
Horner Syndrome Following Intercostal Nerve Block Via an Anterolateral Approach in Breast Lumpectomy: A Prospective Nested Case-control Study.
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乳房肿块切除术中通过前外侧入路进行肋间神经阻滞后的霍纳综合征：一项前瞻性巢式病例对照研究。
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发表时间：
2022
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通讯作者：
Changhong Miao
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作者：
Wenting Hou;Jing Zhong;Xijun Yang;FCheng Ni;Chen Ling;Minzhi Lv;Meilin Weng;Changhong Miao
肿块切除术对于预防良性肿瘤恶变和诊断恶性肿瘤具有重要意义。肋间神经阻滞（ICNB）是有用的乳房肿块切除术作为主要麻醉或作为辅助麻醉程序。据我们所知，还没有研究评估霍纳综合征与ICNB之间的关系。本研究旨在探讨ICNB后霍纳综合征的特点和相关危险因素。嵌套情况-对照研究。复旦大学上海肿瘤医院，2020年4月至2020年7月。招募的根据肿块的位置，在腋中线和肋骨下缘的交叉处引入ICNB。在ICNB后1、5、10、15、30、45和60分钟以及3、6、12和24小时评估Horner综合征指标。记录个人数据（年龄、体重指数阿萨分级）、麻醉数据（穿刺点、局麻药剂量、ICNB持续时间、Horner综合征指标、其他并发症）和术后恢复数据（术后活动时间、术后进食时间）。单因素和多因素Logistic回归分析显示，998例患者中有35例（3.5%）出现同侧Horner综合征。同侧瞳孔缩小是ICNB后最早出现、最后消失的症状，发生在ICNB后4分钟内，持续45分钟至240分钟。7例患者出现明显的同侧面部潮红。Logistic多因素回归分析显示，年龄≤ 45岁、体重指数≤ 18.5 kg/m2、是否需要再次行ICNB是ICNB术后发生Horner综合征的独立危险因素。其次，局麻药的流动轨迹无法被影像示踪剂所证实，经前外侧入路的ICNB促进了乳房肿块切除术后的恢复。ICNB乳腺肿块切除术后Horner综合征的发生率为3.5%。霍纳综合征发生在ICNB的同侧，是可逆的。年龄小、体重指数低、需要第二次ICNB是ICNB后发生霍纳综合征的危险因素。霍纳综合征、肋间神经阻滞、乳房肿块切除术、促进康复。
Lumpectomy is important for preventing malignant changes in benign tumors and diagnosing malignant tumors. Intercostal nerve blocks (ICNBs) are useful for breast lumpectomy as either the primary anesthetic or as an adjuvant anesthetic procedure. To our knowledge, no studies have evaluated the association between Horner syndrome and ICNB.This study aimed to explore the characteristics of and related risk factors for Horner syndrome after ICNB.A prospective, nested case-control study.Fudan University Shanghai Cancer Centre from April 2020 through July 2020.Patients scheduled for breast lumpectomy under ICNB from April 2020 through July 2020 in our hospital were recruited. The ICNB was introduced at the intersection of the midaxillary line and the inferior border of the ribs, according to the location of the mass. Horner syndrome indicators were assessed one, 5, 10, 15, 30, 45, and 60 minutes and 3, 6, 12 and 24 hours after ICNB. Personal data (age, body mass index ASA classes), data on anesthetic (the puncture points, dose of local anesthetics, duration of ICNB, Horner syndrome indicators, other complications) and data on postoperative recovery (postoperative activity time, postoperative feeding time) were recorded. Univariate and multivariate logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals.Ipsilateral Horner syndrome was found in 35 of 998 (3.5%) patients. Ipsilateral miosis, the first symptom to appear and last to disappear, occurred within 4 minutes and lasted 45 minutes to 240 minutes after ICNB. Seven patients showed obvious ipsilateral facial flushing. Logistic multivariate regression analysis showed that independent risk factors for Horner syndrome after ICNB were age <= 45 years, body mass index <= 18.5 kg/m2, and the need for a second ICNB.Firstly, the patients in this study are all adult women, and the applicability of other populations is uncertain. Secondly, the flow trajectory of local anesthetics was not confirmed by imaging tracers.ICNB via an anterolateral approach promoted enhanced recovery after breast lumpectomy. The incidence of Horner syndrome following ICNB for breast lumpectomy was 3.5%. Horner syndrome occurred on the ipsilateral side of the ICNB and was reversible. Younger age, lower BMI, and the need for a second ICNB were risk factors for Horner syndrome after ICNB.Horner's syndrome, intercostal nerve block, breast lumpectomy, enhanced recovery.