超声引导Ⅱ型胸神经阻滞在乳腺癌保乳和前哨淋巴结活检术中的应用

中华养生保健 ›› 2023, Vol. 41 ›› Issue (11): 1-4.

• 论著 • 下一篇

超声引导Ⅱ型胸神经阻滞在乳腺癌保乳和前哨淋巴结活检术中的应用

邓城旗^1,2,3,4,5, 王凯元^1,2,3,4,5, 于凯丽^1,2,3,4,5, 王桂月^1,2,3,4,5, 尹毅青^1,2,3,4,5,*, 黄胜川⁶, 斯朗旺姆⁶

1.天津医科大学肿瘤医院麻醉科,天津,300060;
2.国家恶性肿瘤临床医学研究中心,天津,300060;
3.天津市恶性肿瘤临床医学研究中心,天津,300060;
4.天津市肿瘤防治重点实验室,天津,300060;
5.乳腺癌防治教育部重点实验室,天津,300060;
6.昌都市藏医院麻醉科,西藏昌都,854085

出版日期:2023-06-01 发布日期:2023-05-25
通讯作者: ^*尹毅青,E-mail: yyq518@sina.com。
作者简介:邓城旗（1986—）,男,汉族,籍贯：山西省晋城市,硕士研究生,副主任医师,研究方向：麻醉与认知、疼痛。
基金资助:
天津麻醉科研发展计划项目（TJMZ2022-010）; 天津市医学重点学科（专科）建设项目（TJYXZDXK-009A）

Ultrasound-guided Type Ⅱ Thoracic Nerve Block In Breast Cancer Breast-conserving Surgery and Sentinel Iymph Node Biopsy

DENG Cheng-qi^1,2,3,4,5, WANG Kai-yuan^1,2,3,4,5, YU Kai-li^1,2,3,4,5, WANG Gui-yue^1,2,3,4,5, YIN Yi-qing^1,2,3,4,5,*, HUANG Sheng-chuan⁶, Silangwangmu⁶

1. Department of Anesthesiology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China;
2. National Clinical Research Center for Cancer, Tianjin 300060, China;
3. Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China;
4. Key laboratory of Cancer Prevention and Therapy, Tianjin 300060, China;
5. Key laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, China;
6. Department of Anesthesiology, Changdu Tibetan Medical Hospital, Changdu Xizang 854085, China

Online:2023-06-01 Published:2023-05-25

摘要/Abstract

摘要： 目的评估超声引导下Ⅱ型胸神经阻滞（pectoral nerves block Ⅱ,PECS-Ⅱ）在乳腺癌保乳和前哨淋巴结活检术中的镇痛效果。方法选择2022年6月—2022年11月在天津医科大学肿瘤医院择期行单侧乳腺癌保乳术和前哨淋巴结活检术患者60例,采用随机数表法将患者分为对照组和PECS-Ⅱ组,每组30例。对照组常规喉罩全身麻醉,PECS-Ⅱ组在手术结束后苏醒前行超声引导下PECS-Ⅱ阻滞。采用数字评定量表（numerical rating scale,NRS）评估术后1 h、6 h、12 h、24 h两组患者乳房和腋窝的疼痛强度,术后24 h评估15项恢复质量（15-item Quality of Recovery,QoR-15）以及记录阿片类药物总消耗量和不良反应发生情况。结果与对照组相比,PECS-Ⅱ组术后1 h、6 h乳房NRS评分显著降低,差异有统计学意义（P<0.05）,术后1 h、6 h、12 h、24 h腋窝NRS评分均显著降低,差异有统计学意义（P<0.05）。PECS-Ⅱ组术后 24 h QoR-15评分明显高于对照组,差异有统计学意义（P<0.05）。PECS-Ⅱ组术后24 h阿片类药物总消耗量及不良反应发生率均明显低于对照组,差异有统计学意义（P<0.05）。结论超声引导Ⅱ型胸神经阻滞可明显降低乳腺癌保乳和前哨淋巴结活检术后24 h乳房和腋窝的疼痛强度,提高患者术后早期恢复质量。

关键词: Ⅱ型胸神经阻滞, 乳腺癌, 保乳术, 前哨淋巴结活检术, 术后镇痛, 早期恢复质量

Abstract: Objective To evaluate the analgesic effect of ultrasound-guided type Ⅱ thoracic nerve block (PECS-Ⅱ) in breast cancer breast-conserving and sentinel lymph node biopsy. Methods Sixty patients undergoing elective unilateral breast-conserving surgery and sentinel lymph node biopsy in Tianjin Medical University Cancer Hospital from June to November 2022 were selected and divided into control group and PECS-Ⅱ group, 30 patients in each group using randomized number table. Control group was under general anesthesia with conventional laryngeal mask, while group P underwent ultrasound-guided PECS-Ⅱ block before awakening after surgery. Numerical rating scale (NRS) was used to assess the pain intensity in the breast and axilla of patients at 1 h, 6 h, 12 h and 24 h postoperatively. The 15-item Quality of Recovery (QoR-15) and the recording of total opioid consumption and adverse effects were assessed at 24 h postoperatively. Results There was no statistical difference between the two groups in terms of basic patient information. Compared with control group, the NRS scores were significantly lower in PECS-Ⅱ group at 1 h and 6 h after mastectomy (P<0.05), and in the axilla at 1 h, 6 h, 12 h, and 24 h after surgery (P<0.05). The 24 h postoperative QoR-15 score was significantly higher in PECS-Ⅱ group than in control group (P<0.05). Total opioid consumption and side effects were significantly lower in PECS-Ⅱ group than in control group 24 h postoperatively (P<0.05). Conclusion Ultrasound-guided type Ⅱ thoracic nerve block significantly reduced the intensity of breast and axillary pain 24 hours after breast cancer conservation and sentinel lymph node biopsy and improved the quality of patients' early postoperative recovery.

Key words: type Ⅱ, thoracic nerve block, breast cancer, breast-conserving surgery, sentinel lymph node biopsy, postoperative analgesia, early recovery quality

中图分类号:

R614.4

邓城旗, 王凯元, 于凯丽, 王桂月, 尹毅青, 黄胜川, 斯朗旺姆. 超声引导Ⅱ型胸神经阻滞在乳腺癌保乳和前哨淋巴结活检术中的应用[J]. 中华养生保健, 2023, 41(11): 1-4.

DENG Cheng-qi, WANG Kai-yuan, YU Kai-li, WANG Gui-yue, YIN Yi-qing, HUANG Sheng-chuan, Silangwangmu. Ultrasound-guided Type Ⅱ Thoracic Nerve Block In Breast Cancer Breast-conserving Surgery and Sentinel Iymph Node Biopsy[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(11): 1-4.

参考文献

[1] LOIBL S, POORTMANS P, MORROW M, et al.Breast cancer[J]. Lancet,2021,397(10286):1750-1769.
[2] WANG X, WANG C, GUAN J, et al.Progress of Breast Cancer basic research in China[J]. Int J Biol Sci,2021,17(8):2069-2079.
[3] NANDA A, HU J, HODGKINSON S, et al. Oncoplastic breast-conserving surgery for women with primary breast cancer[J]. Cochrane Database Syst Rev,2021,10(10):CD013658.
[4] SPIVEY T L, GUTOWSKI E D, ZINBOONYAHGOON N, et al.Chronic Pain After Breast Surgery: A Prospective, Observational Study[J]. Ann Surg Oncol,2018,25(10):2917-2924.
[5] FUZIER R, SALVIGNOL G, GILBERT O, et al.Influence of Deep Serratus Anterior Plane Block on Chronic Pain at 3 Months After Breast-Conserving Surgery: Prospective, Cohort Study[J]. Clin J Pain,2022,38(6):418-423.
[6] MONIB S, ABDELAZIZ M I.Epidemiology and Predictive Factors for Persistent Breast Pain Following Breast-Conserving Surgery[J]. Cureus, 2021,13(3):e14063.
[7] KAROO K, KUMAR M, SINHA M, et al.A randomised prospective single-blind pilot study to compare the analgesic efficacy of thoracic epidural block and erector spinae plane block in breast cancer surgery[J]. Indian J Anaesth, 2022,66(Suppl 3):S148-S153.
[8] CORMIER N S, STEIN M J, ZHANG T, et al.Epidural Nerve Blocks Increase Intraoperative Vasopressor Consumption and Delay Surgical Start Time in Deep Inferior Epigastric Perforator Free Flap Breast Reconstruction[J]. Plast Reconstr Surg Glob Open, 2019, 7(1):e2105.
[9] HOUSE L M, BARRETTE K, MATTIE R, et al.Cervical Epidural Steroid Injection: Techniques and Evidence[J]. Phys Med Rehabil Clin N Am,2018,29(1):1-17.
[10] SCHWEMMER U.Breast surgery and peripheral blocks. Is it worth it?[J]. Curr Opin Anaesthesiol,2020,33(3):311-315.
[11] 许奎斌,张霄蓓,舒瑞辰,等.Ⅱ型胸部神经阻滞对乳腺癌改良根治术患者围术期应激反应的影响[J].中国肿瘤临床,2020,47(18):935-938.
[12] WESSELS E, PERRIE H, SCRIBANTE J, et al.Quality of recovery in the perioperative setting: A narrative review[J]. J Clin Anesth,2022,78:110685.
[13] GRAPE S, JAUNIN E, EL-BOGHDADLY K, et al.Analgesic efficacy of PECS and serratus plane blocks after breast surgery: A systematic review, meta-analysis and trial sequential analysis[J]. J Clin Anesth,2020,63:109744.
[14] KOKOSIS G, CHOPRA K, DARRACH H, et al.Re-visiting post-breast surgery pain syndrome: risk factors, peripheral nerve associations and clinical implications[J]. Gland Surg,2019,8(4):407-415.
[15] VERSYCK B, GROEN G, VAN GEFFEN G J, et al. The pecs anesthetic blockade: A correlation between magnetic resonance imaging, ultrasound imaging, reconstructed cross-sectional anatomy and cross-sectional histology[J]. Clin Anat,2019,32(3):421-429.
[16] DE CASSAI A, BONANNO C, SANDEI L,et al.PECS Ⅱ block is associated with lower incidence of chronic pain after breast surgery[J]. Korean J Pain,2019,32(4):286-291.
[17] KURIEN R K, SALINS S R, JACOB P M, et al.Utility of Pecs Block for Perioperative Opioid-Sparing Analgesia in Cancer-Related Breast Surgery: A Randomized Controlled Trial[J]. Indian J Surg Oncol,2021,12(4):713-721.
[18] VERSYCK B, VAN GEFFEN G J, CHIN K J. Analgesic efficacy of the Pecs II block: a systematic review and meta-analysis[J]. Anaesthesia,2019,74(5):663-673.
[19] ROBINSON H, MISHRA S, DAVIES L, et al.Anatomical Evaluation of a Conventional Pectoralis II Versus a Subserratus Plane Block for Breast Surgery[J]. Anesth Analg,2020,131(3):928-934.
[20] SENAPATHI T G A, WIDNYANA I M G, ARIBAWA I G N M, et al. Combined ultrasound-guided Pecs II block and general anesthesia are effective for reducing pain from modified radical mastectomy[J]. J Pain Res,2019,12:1353-1358.
[21] BERNING V, HEIDEGGER T, LAUPHEIMER M, et al.Patient satisfaction and quality of recovery[J]. Anaesthesia,2018,73(4):521-522.
[22] BOWYER A, ROYSE C.Approaches to the measurement of post-operative recovery[J]. Best Pract Res Clin Anaesthesiol,2018,32(3-4):269-276.
[23] KLEIF J, WAAGE J, CHRISTENSEN K B,et al.Systematic review of the QoR-15 score, a patient- reported outcome measure measuring quality of recovery after surgery and anaesthesia[J]. Br J Anaesth,2018,120(1):28-36.
[24] JANC J, SZAMBORSKI M, MILNEROWICZ A, et al.Evaluation of the Effectiveness of Modified Pectoral Nerve Blocks Type Ⅱ(PECS Ⅱ) for Vascular Access Port Implantation Using Cephalic Vein Venesection[J]. J Clin Med,2021,10(24):5759.
[25] 王爽,黄晨晨,夏琴,等.前锯肌平面联合胸横肌平面阻滞在乳腺癌改良根治术中的临床应用[J].西部医学,2020,32(12):1835-1840.
[26] UESHIMA H, OTAKE H, HARA E, et al.How to Use Pectoral Nerve Blocks Effectively—An Evidence-Based Update[J]. Asian J Anesthesiol,2019,57(2):28-36.

超声引导Ⅱ型胸神经阻滞在乳腺癌保乳和前哨淋巴结活检术中的应用

Ultrasound-guided Type Ⅱ Thoracic Nerve Block In Breast Cancer Breast-conserving Surgery and Sentinel Iymph Node Biopsy

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