Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy
Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy
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DOI：
10.1213/01.ane.0000136775.15566.87
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发表时间：
2004-12-01
影响因子：
5.7
通讯作者：
Pere, PJ
中科院分区：
文献类型：
--
作者：
Kairaluoma, PM;Bachmann, MS;Pere, PJ
椎旁阻滞（PVB）似乎可以减轻乳房手术后的术后疼痛和术后恶心呕吐（PONV），但这些研究尚未进行安慰剂对照。我们研究了 60 名计划进行乳腺癌手术的患者，在全身麻醉前，在 T3 时随机注射 PVB 布比卡因 5 mg/mL (1.5 mg/kg) 或生理盐水。患者和参与调查的人员均处于失明状态； PVB 或假手术阻滞由未参与该研究的麻醉师在幕后进行。与对照组患者相比，接受 PVB 联合布比卡因治疗的患者在麻醉后护理室中需要的电视阿片类药物（主要结果变量）减少了 40%，首次阿片类药物剂量的潜伏期更长，并且 24 小时后静息时的疼痛更少（P < 0.01）。他们在麻醉后监护室中的 PONV 也较少（P < 0.05），在 90 分钟之前镇静较少（P < 0.05），并且在术后 90 分钟的数字符号替换测试和术后 60-120 分钟的眼部协调测试中表现更好（P < 0.05）。平均峰值布比卡因血浆浓度为 750 ng/mL。 1例患者注射布比卡因后立即出现双侧抽搐。我们的结论是，乳腺癌手术全身麻醉前的 PVB 可以减少术后疼痛、阿片类药物的消耗和 PONV 的发生，并改善麻醉恢复。
Paravertebral block (PVB) seems to decrease postoperative pain and postoperative nausea and vomiting (PONV) after breast surgery, but the studies have not been placebo controlled. We studied 60 patients scheduled for breast cancer surgery randomly given single injection PVB at T3 with bupivacaine 5 mg/mL (1.5 mg/kg) or saline before general anesthesia. The patient and attending investigators were blinded; the PVB or the sham block was performed behind a curtain by an anesthesiologist not involved in the Study. The patients given PVB with bupivacaine needed 40% less TV opioid medication (primary outcome variable) in the postanesthesia care unit, had a longer latency to the first opioid dose, and had less pain at rest after 24 h than the control patients (P < 0.01). They also had less PONV in the postanesthesia care unit (P < 0.05), were less sedated until 90 min (P < 0.05), and performed better in the digit symbol substitution test at 90 min and the ocular coordination test 60-120 min after surgery (P < 0.05). The average peak bupivacaine plasma concentration was 750 ng/mL. One patient had bilateral convulsions immediately after bupivacaine injection. We conclude that PVB before general anesthesia for breast cancer surgery reduced postoperative pain, opioid consumption, and occurrence of PONV and improved recovery from anesthesia.