Preincisional paravertebral block reduces the prevalence of chronic pain after breast surgery.
Preincisional paravertebral block reduces the prevalence of chronic pain after breast surgery.
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切口前椎旁阻滞可减少乳房手术后慢性疼痛的发生率。
DOI：
10.1016/j.acpain.2007.02.012
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发表时间：
2007
影响因子：
5.7
通讯作者：
P. Pere
中科院分区：
文献类型：
--
作者：
P. Kairaluoma;M. Bachmann;P. Rosenberg;P. Pere
结论：除了提供术后急性疼痛缓解外，术前椎旁阻滞（PVB）可降低乳腺癌手术后1年慢性疼痛的发生率和强度。急性和长期的镇痛效果应该鼓励在乳腺癌手术前使用PVB。乳房手术后1年，手术部位和同侧手臂的慢性疼痛症状很普遍（1,2）。出乎意料的是，发现保乳手术后慢性疼痛比根治性手术更常见(3)。术后急性疼痛的强度、手术类型、局部淋巴结的受累程度和放疗被认为是乳腺癌患者慢性疼痛的最重要的治疗相关因素（2,4）。椎旁阻滞（PVB）可作为乳房手术的唯一麻醉技术（5,6）；但是，也许在今天，PVB更常用于全麻诱导前后，以提供乳房手术后的术后镇痛（7-10）。我们曾报道过乳腺癌手术患者术前PVB术后良好的即时术后镇痛(8)。良好的急性疼痛缓解与手术区发生慢性疼痛的风险较低相关（4,11,12）。因此，我们对60名参与PVB研究的乳腺癌患者进行了为期1年的随访(8)，以确定术前PVB是否与乳房手术后长期疼痛的减少有关。方法：我们获得了机构伦理委员会的批准和书面知情患者同意，对60例接受乳腺癌手术的患者进行了前瞻性、随机、安慰剂对照、单盲结局研究(8)。全麻前，30例患者在T3给予0.5%布比卡因1.5 mg/kg的PVB （PVB组），30例患者在相应穿刺部位皮下给予生理盐水假阻滞（假手术组）(8)。考虑到患者的安全性，我们发现假手术患者在用硬膜外针接触椎突后不需要识别椎旁间隙，但除此之外，两组的阻滞方法相似。一名工作麻醉师，没有参与随访评估，在窗帘后进行手术，以便患者、她的主治麻醉师和护理人员对阻滞和研究药物不知情。这些患者计划进行保守性乳腺癌手术，并伴有放射性同位素引导（SENTINEL）淋巴结活检。若发现淋巴结转移，则行腋窝清扫术。原发肿瘤较大、激素受体阴性、II-III期癌症或腋窝转移的患者接受术后化疗（13,14）。原发肿瘤大、腋窝转移、皮肤或肌肉浸润，均行保乳手术的患者术后均行放疗。
IMPLICATIONS: In addition to providing acute postoperative pain relief, preoperative paravertebral block (PVB) decreases the prevalence and intensity of chronic pain as late as 1 yr after breast cancer surgery. The acute and long-term analgesic benefits should encourage the use of PVB before breast cancer surgery.Chronic pain symptoms in the operated area and the ipsilateral arm are prevalent 1 yr after breast surgery (1, 2). Unexpectedly, chronic pain has been found to be more common after breast-conserving surgery than radical surgery (3). The intensity of acute postoperative pain, the type of operation, involvement of regional lymph nodes, and radiotherapy have been considered the most important treatment-related factors predisposing to chronic pain in patients with breast cancer (2, 4). Paravertebral block (PVB) can be used as the sole anesthetic technique for breast surgery (5, 6); but, perhaps more frequently today, PVB is used before or after the induction of general anesthesia to provide postoperative analgesia after breast surgery (7–10). We have reported earlier good immediate postoperative analgesia after preincisional PVB in patients undergoing breast surgery for cancer (8). Good acute pain relief is associated with a lower risk of development of chronic pain in the operative area (4, 11, 12). Therefore, we performed a 1-yr follow-up in 60 breast cancer patients who participated in our PVB study (8) to determine whether the preincisional PVB would be associated with less long-term pain after breast surgery.METHODSWe obtained Institutional Ethics Committee approval and written informed patient consent for a prospective, randomized, placebo-controlled, and single-blind outcome study in 60 patients who underwent breast surgery for cancer (8). Before general anesthesia, 30 patients were given a PVB (PVB group) with 0.5% bupivacaine 1.5 mg/kg at T3, and 30 patients received a sham block (sham group) with saline subcutaneously at the corresponding puncture site (8). Regarding the safety of the patients, we did not find it necessary to identify the paravertebral space in the sham patients after contacting the transverse process with the epidural needle, but otherwise, the block was performed similarly in both groups. A staff anesthesiologist, not participating in the follow-up assessment, performed the procedure behind a drape curtain so that the patient, her attending anesthesiologist, and the nursing staff were blinded to the block and study drugs. The patients were scheduled for conservative breast cancer surgery with associated radioisotope guided (SENTINEL) lymph node biopsy. Axillary dissection was performed if lymph node metastases were detected. Patients with a large primary tumor, hormone receptor negative, stage II–III cancer, or axillary metastases received postoperative chemotherapy (13, 14). Patients with a large primary tumor, axillary metastases, infiltration into skin or muscle, and all with breast-conserving surgery received postoperative radiotherapy.
影响因子：
3.1
作者：
Mossey, JM;Gallagher, RM
通讯作者：
Gallagher, RM