Pain control in augmentation mammaplasty using indwelling catheters in 687 consecutive patients: data analysis.
Pain control in augmentation mammaplasty using indwelling catheters in 687 consecutive patients: data analysis.
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DOI：
10.1016/j.asj.2008.09.001
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发表时间：
2008-11-01
影响因子：
2.9
通讯作者：
Werner, Catherine
中科院分区：
文献类型：
--
作者：
Pacik, Peter T;Nelson, Craig E;Werner, Catherine
背景：隆胸手术后的疼痛可能会导致严重的残疾。作者之前发表的针对 644 名连续隆乳手术患者的前瞻性研究表明，使用留置导管进行术后滴注布比卡因对于术后疼痛管理既安全又有效。 目的：本研究分析了大量隆乳手术患者，不仅比较导管控制与全身性镇痛药的有效性，而且还描绘疼痛部位并确定是否有多种因素影响术后疼痛。方法：对所有患者进行问卷调查，记录局麻滴注后疼痛减轻的程度、患者对各种镇痛药的偏好以及术后疼痛的部位。使用统计分析研究了与疼痛的潜在相关性，包括儿童数量、年龄、惯用手、术前恐惧、疼痛耐受性和麻醉剂使用时间。还对手术方面进行了研究，例如种植体的大小、不对称种植体的使用、术中扩张、手术持续时间以及尖锐与钝性分离，以确定这些因素是否影响术后疼痛。结果：术后当天晚上自行服用布比卡因可减轻 89% 的患者疼痛。患者对局部麻醉的滴注给予了很高的偏好评分，与全身麻醉药维柯丁（雅培实验室，雅培公园，伊利诺伊州）和Percocet（远藤制药公司，查兹福特，宾夕法尼亚州）所获得的评分相当。布洛芬和美索巴莫的患者评分较低。患者发现术后疼痛的多个部位，包括胸骨、腋窝、外肋骨、乳房顶部（锁骨下）、肩胛间区域和肩膀。老年患者经历的疼痛较少。报告疼痛更严重、恐惧程度更高和胸骨疼痛的患者使用麻醉药的时间更长。手术持续时间、钝性解剖与锐性解剖以及术中扩张与疼痛没有显着相关。综合假体尺寸与疼痛无关，但在不对称假体的情况下，较大一侧的疼痛更大（无统计学意义）。结论：隆胸手术后的疼痛可能受到多种因素的影响，但这些因素似乎与假体尺寸、具体手术技术（钝器与锐性解剖）或手术持续时间无关。疼痛不仅可能涉及乳房，还可能涉及胸骨、胸部两侧、腋窝、锁骨下和肩胛间区域。使用留置导管滴注长效麻醉剂的疗效与全身麻醉剂维柯丁和Percocet相当。胸骨疼痛可能很严重，可能需要麻醉剂才能有效控制疼痛。
BACKGROUND: Postoperative pain following augmentation mammaplasty can cause significant disability. In the authors' previously published prospective study of 644 consecutive augmentation mammaplasty patients, it was shown that the use of indwelling catheters for the postoperative instillation of bupivacaine is both safe and effective in postoperative pain management.OBJECTIVE: This study analyzes a large population of augmentation mammaplasty patients to not only compare the effectiveness of catheter control with systemic analgesics but also to delineate sites of pain and determine if any of a variety of factors influence postoperative pain.METHODS: Questionnaires were given to all patients to record the extent of pain reduction following the instillation of local anesthesia, patient preference for a variety of analgesics, and the locations of postoperative pain. Potential correlations to pain-including the number of children, age, handedness, preoperative fear, pain tolerance, and length of narcotic use-were investigated using statistical analysis. Operative aspects, such as the size of implants, use of asymmetrical implants, intraoperative expansion, duration of surgery, and sharp versus blunt dissection were also studied to determine if these factors influenced postoperative pain.RESULTS: Self-administration of bupivacaine the evening after surgery achieved pain reduction in 89% of patients. Patients gave high preference scores for the instillation of local anesthesia, comparable to rates achieved with the systemic narcotics Vicodin (Abbott Laboratories, Abbott Park, IL) and Percocet (Endo Pharmaceuticals, Chadds Ford, PA). Lower patient ratings were given to ibuprofen and methocarbamol. Patients identified multiple sites of postoperative pain, including the sternum, armpits, outer ribs, top of the breast (infraclavicular), interscapular region, and shoulders. Older patients experienced less pain. Patients who reported more pain, higher levels of fear, and sternal pain used narcotics for a longer period of time. Duration of surgery, blunt versus sharp dissection, and intraoperative expansion were not significantly related to pain. Combined implant size did not correlate with pain, though in the case of asymmetrical implants, greater pain (not statistically significant) on the larger side was reported.CONCLUSIONS: Postoperative pain following augmentation mammaplasty may be influenced by several factors, but these appear unrelated to implant size, specific operative techniques (blunt versus sharp dissection), or duration of surgery. Pain may involve not only the breasts, but also the sternum, sides of the chest, armpits, and infraclavicular and interscapular areas. The use of indwelling catheters for the instillation of a long-acting anesthetic is rated comparable in efficacy to the systemic narcotics Vicodin and Percocet. Sternal pain can be severe and may require narcotics for effective pain control.