The Efficacy of Ultrasound-guided Type II Pectoral Nerve Blocks in Perioperative Pain Management for Immediate Reconstruction After Modified Radical Mastectomy A Prospective, Randomized Study
The Efficacy of Ultrasound-guided Type II Pectoral Nerve Blocks in Perioperative Pain Management for Immediate Reconstruction After Modified Radical Mastectomy A Prospective, Randomized Study
复制标题
DOI：
10.1097/ajp.0000000000000529
复制
发表时间：
2018-03-01
影响因子：
2.9
通讯作者：
Zhou, Peng
中科院分区：
文献类型：
--
作者：
Wang, Kaiyuan;Zhang, Xiaobei;Zhou, Peng
目的：胸神经（佩奇）II阻滞是一种将局部麻醉剂置于胸肌之间以阻滞腋窝和乳房区域的技术。本研究旨在比较佩奇II阻滞全麻与单纯全麻在改良根治术后即刻单侧乳房再造中的镇痛效果和副作用。材料与方法：64例改良根治术后即刻乳房再造患者随机分为佩奇II阻滞全麻组（P组，n = 32）和单纯全麻组（G组，n = 32）。麻醉诱导后，P组患者接受佩奇II阻滞。主要终点是术后重症监护室中术后最初24小时内的吗啡用量。术中芬太尼的消耗，视觉模拟量表评分，肩关节活动范围，术后恶心和呕吐也进行了assessed.Results：60例患者完成了研究。与G组患者相比，P组患者术后吗啡用量（3.67 mg; 95%置信区间，2.91 - 4.51 mg）和术中芬太尼用量显著减少。术后恶心和呕吐（相对风险0.22; 95%置信区间，0.05 - 0.94）和较低的视觉模拟量表评分也观察到在P组。没有块相关的并发症recorded.Discussion：当患者接受立即乳房重建植入体和背阔肌皮瓣，佩奇II块提供了一个全面的块相关的神经在手术区域，因此可以提供上级镇痛和减少围手术期阿片类药物的使用没有明显的块相关的并发症。
Objectives:The pectoral nerves (Pecs) II block is a technique that places local anesthetic between the thoracic muscles to block the axillary and breast regions. This study aimed to compare the quality of perioperative analgesia and side effects of the Pecs II block under general anesthesia versus general anesthesia alone in immediate unilateral breast reconstruction with an implant and latissimus dorsi flap after modified radical mastectomy.Materials and Methods:Sixty-four patients scheduled for immediate breast reconstruction after modified radical mastectomy were randomly allocated into the Pecs II block under general anesthesia group (group P, n=32) or the general anesthesia alone group (group G, n=32). After anesthesia induction, patients in group P underwent a Pecs II block. The primary endpoint was postoperative morphine consumption in the first 24 hours in postoperative intensive care unit. Intraoperative fentanyl consumption, visual analog scale scores, shoulder range of motion, and postoperative nausea and vomiting were also assessed.Results:Sixty patients completed the study. There was a significant reduction in postoperative morphine consumption (3.67 mg; 95% confidence interval, 2.91-4.51 mg) and intraoperative fentanyl consumption in group P patients compared with group G patients. Less postoperative nausea and vomiting (relative risk 0.22; 95% confidence interval, 0.05-0.94) and lower visual analog scale scores were also observed in group P. No block-related complications were recorded.Discussion:When patients underwent immediate breast reconstruction with an implant and latissimus dorsi flap, the Pecs II block offers a comprehensive block of associated nerves in the surgical area, and therefore can provide superior analgesia and reduced perioperative opioids use without obvious block-related complications.