区域干预对简单乳腺癌手术的潜在益处尚未得到很好的研究。了解哪些患者不提供区域干预可能与了解哪些患者受益同样重要。尚不清楚筋膜平面是否阻塞,如前锯肌平面(SAP)阻滞,对于不太广泛的乳房手术,应常规进行。因此,在这项回顾性队列研究中,我们的目的是评估在接受单纯肿块切除术(无淋巴结活检)并使用阿片类药物的患者中,将SAP阻滞纳入标准的围手术期多模式镇痛计划的相关性.作为次要结果,我们还分析了术后疼痛评分和麻醉后监护病房(PACU)住院时间.
这是一项单机构回顾性队列研究(仅手术部位浸润与SAP阻滞队列),评估SAP阻滞与我们感兴趣的结果的关联。在调整后的分析中,我们使用1:1(仅手术部位浸润:SAP阻断)倾向评分匹配,使用最近邻匹配,无需替换,创建匹配队列.为了比较匹配队列中的主要和次要结果,我们用了Wilcoxon符号秩检验.P值<0.05被认为具有统计学意义。
分析中纳入了419例患者,其中116例(27.7%)除了我们的标准围手术期镇痛计划外,还在术前接受了SAP阻滞.在未经调整的分析中,围手术期阿片类药物用量无差异,PACU疼痛评分,和PACU停留时间。在匹配的队列中,与SAP阻滞组相比,仅手术部位浸润组的围手术期阿片类药物消耗中位数[四分位数]分别为10mg[10,13.25mg]和10mg[7,15mg],分别为(P=0.16)。其他结果没有差异。
在这项研究中,我们评估了SAP阻滞对接受简单肿块切除术的患者的影响,相对较少的乳房手术。我们得出的结论是,常规使用术前区域麻醉对这些特定患者不利。未来的研究应该集中在确定将直接受益于区域干预的患者。
The potential benefit of regional interventions for simple lumpectomy breast cancer surgeries has not been well investigated. Understanding which patients to not offer a regional intervention to can be just as important as knowing which would benefit. It is unclear whether fascial plane blocks, such as serratus anterior plane (SAP) block, should be routinely performed for less extensive breast surgeries. Therefore, our goal in this retrospective cohort study was to evaluate the association of integrating SAP blocks into a standard perioperative multimodal analgesia plan in patients undergoing simple lumpectomies (without node biopsies) with perioperative opioid consumption. As secondary outcomes, we also analyzed postoperative pain scores and post-anesthesia care unit (PACU) length of stay.
This was a single institution retrospective cohort study (surgical site infiltration only versus SAP block cohorts) assessing the association of SAP blocks to our outcomes of interest. In the adjusted analysis, we created matched cohorts using 1:1 (surgical site infiltration only: SAP block) propensity-score matching using nearest neighbor-matching without replacement. To compare the primary and secondary outcomes in the matched cohorts, we used the Wilcoxon signed rank test. A P-value of < 0.05 was considered statistically significant.
There were 419 patients included in the analysis, in which 116 (27.7%) received a SAP block preoperatively in addition to our standard perioperative analgesia plan. In an unadjusted analysis, no differences were seen in perioperative opioid consumption, PACU pain scores, and PACU length of stay. Among the matched cohorts, the median [quartile] perioperative opioid consumption in the surgical site infiltration only versus SAP block cohorts were 10 mg [10, 13.25 mg] and 10 mg [7, 15 mg], respectively (P = 0.16). No differences were seen in the other outcomes.
In this study, we evaluated the impact of SAP blocks on patients undergoing simple lumpectomies, which are relatively less involved breast surgeries. We concluded that routine use of preoperative regional anesthesia is not beneficial for these specific patients. Future studies should focus on identifying patients that would directly benefit from regional interventions.