胸大肌和前锯肌平面阻滞都能给门诊乳腺癌手术术后带来早期镇痛益处：回顾性倾向匹配队列研究
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Pectoralis and Serratus Fascial Plane Blocks Each Provide Early Analgesic Benefits Following Ambulatory Breast Cancer Surgery: A Retrospective Propensity-Matched Cohort Study
背景与目的
胸大肌和前锯肌阻滞最近已经应用于乳腺手术，但是支持镇痛益处的证据有限。此队列研究评估了女子大学附属医院2013年7月到2015年5月间接受门诊乳腺癌手术的患者镇痛益处，这个益处就是传统的阿片类镇痛（对照）加胸大肌或前锯肌阻滞。我们测试了联合假设，即增加胸大肌或前锯肌阻滞可以减少在院术后（或者出院）阿片类药物用量和恶心、呕吐（PONV）。我们还研究了2种类型的非劣性阻滞。
方 法
总共225名患者在5个潜在混杂因素下倾向性匹配到3个研究组（每组75名）：（1）胸大肌组;（2）前锯肌组（3）对照组。倾向匹配队列研究被用来评估术后住院口服吗啡量和恶心呕吐相关的研究。我们认为如果它们是两种非劣性结果，胸大肌阻滞效果劣于前锯肌阻滞，10毫克吗啡和17.5％的恶心呕吐发生率相关。其他结果包括术中芬太尼的需求，疼痛评分，请求首次镇痛时间，和恢复室的停留时间。
结 果
与对照组相比，胸大肌和前锯肌阻滞都与术后减少阿片类药物使用量及PONV有关。胸大肌组的2类结果不逊于前锯肌组，胸大肌和前锯肌阻滞都与术中减少芬太尼需要，延长首次镇痛时间，加速撤离恢复室有关。其它结果无差异。
结 论
与传统阿片类药物镇痛相比较，门诊乳腺癌术后，胸大肌和前锯肌阻滞与减少术后在院阿片类药物使用量和恶心呕吐有关。
原始文献摘要
Abdallah F W, Maclean D, Madjdpour C, et al. Pectoralis and Serratus Fascial Plane Blocks Each Provide Early Analgesic Benefits Following Ambulatory Breast Cancer Surgery: A Retrospective Propensity-Matched Cohort Study.[J]. Anesthesia & Analgesia, 2017, 125.
BACKGROUND: Pectoralis and serratus blocks have been described recently for use in breast surgery, but evidence supporting their analgesic benefits is limited. This cohort study evaluates the benefits of adding a pectoralis or serratus block to conventional opioid-based analgesia (control) in patients who underwent ambulatory breast cancer surgery at Women’s College Hospital between July 2013 and May 2015. We tested the joint hypothesis that adding a pectoralis or serratus block reduced postoperative in-hospital (predischarge) opioid consumption and nausea and vomiting (PONV). We also examined the 2 block types for noninferiority.
METHODS: A total of 225 patients were propensity matched on 5 potential confounders among 3 study groups (75 per group): (1) pectoralis; (2) serratus; and (3) control. The propensity-matched cohort was used to evaluate the effect of the study group on postoperative in-hospital oral morphine equivalent consumption and PONV. We considered pectoralis noninferior to serratus block if it was noninferior for both outcomes, within 10 mg morphine and 17.5% in PONV incidence margins. Other outcomes included intraoperative fentanyl requirements, pain scores, time to first analgesic request, and duration of recovery room stay.
RESULTS: Both pectoralis and serratus blocks were each associated with reduced postoperative in-hospital opioid consumption and PONV compared with control. Pectoralis was noninferior to serratus block for these 2 outcomes. Pectoralis and serratus blocks were each associated with reduced intraoperative fentanyl requirements, prolonged time to frst analgesic request, and expedited recovery room discharge compared with control; there were no differences for the remaining outcomes.
CONCLUSIONS: Pectoralis and serratus blocks were each associated with a reduction in postoperative in-hospital opioid consumption and PONV compared with conventional opioid-based analgesia after ambulatory breast cancer surgery.
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