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| 布比卡因脂质体胸横肌平面-胸部神经阻滞对乳腺癌改良根治术后疼痛的影响 |
| Impact of liposomal bupivacaine-based transversus thoracic muscle plane-pectoral nerve block on postoperative pain following modified radical mastectomy for breast cancer |
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| DOI：10.12089/jca.2026.07.004 |
| 中文关键词: 布比卡因脂质体 胸横肌平面-胸部神经阻滞 胸神经 神经阻滞 乳腺癌改良根治术 镇痛 |
| 英文关键词: Liposomal bupivacaine Transversus thoracic muscle plane-pectoral nerves block Thoracic nerves Nerve block Modified radical mastectomy Analgesia |
| 基金项目:中国红十字基金会医学赋能公益专项基金（2023-4-81） |
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| 中文摘要: |
目的：探讨布比卡因脂质体胸横肌平面-胸部神经Ⅱ型（TTP-PECS Ⅱ）阻滞用于乳腺癌改良根治术，对其术后疼痛的影响。
方法：选择择期行乳腺癌改良根治术的女性患者，年龄18～64岁，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：布比卡因脂质体联合布比卡因组（LB组）和布比卡因组（B组）。两组均在麻醉诱导前行超声引导下TTP-PECS Ⅱ阻滞：LB组神经阻滞药物为布比卡因脂质体266 mg联合布比卡因112.5 mg；B组神经阻滞药物为单纯布比卡因112.5 mg。主要指标为术后6～72 h静息时VAS疼痛评分的曲线下面积（AUCVAS）。次要指标包括术中瑞芬太尼用量、术中出血量、术中补液量和手术时间，术后6、24、48、72 h静息时VAS疼痛评分，术后补救镇痛率，首次补救镇痛时间，术后72 h内曲马多用量。不良反应包括神经损伤、气胸、血管内注射和局部麻醉毒性等神经阻滞相关不良反应和瘙痒、头晕、术后恶心呕吐等阿片类药物相关不良反应。
结果：共纳入患者79例，LB组40例，B组39例。与B组比较，LB组术后6～72 h静息时AUCVAS、术后24、48、72 h静息时VAS疼痛评分、补救镇痛率、术后恶心呕吐发生率明显降低，首次补救镇痛时间明显延长，术后72 h内曲马多用量明显减少（P<0.05）。两组术中瑞芬太尼用量、术中出血量、术中补液量和手术时间差异无统计学意义。
结论：在乳腺癌改良根治术患者中，术前布比卡因脂质体联合布比卡因行TTP-PECS Ⅱ阻滞能够提供术中至术后72 h的长程镇痛效果。 |
| 英文摘要: |
Objective: To evaluate the analgesic efficacy of transversus thoracic muscle plane-pectoral nerves type Ⅱ ( TTP-PECS Ⅱ) block using liposomal bupivacaine for postoperative pain control in patients undergoing modified radical mastectomy.
Methods: Female patients scheduled for modified radical mastectomy were included, aged 18-64 years, ASA physical status Ⅰ or Ⅱ. The patients were randomly assigned to two groups using a random number table: liposomal bupivacaine + bupivacaine group (group LB) and bupivacaine group (group B). Both groups received ultrasound-guided TTP-PECS Ⅱ block before anesthesia induction. Patients in group LB received a nerve block with liposomal bupivacaine 266 mg plus bupivacaine 112.5 mg, while those in group B received bupivacaine 112.5 mg alone. The primary outcome was the area under the curve of VAS pain scores (AUCVAS) at rest within 6-72 hours postoperatively. Secondary outcomes included intraoperative remifentanil dosage, intraoperative blood loss, intraoperative fluid volume, operative time, VAS pain scores at rest at 6, 24, 48, and 72 hours postoperatively, the number of rescue analgesic procedures, the time to the first rescue analgesia, and the total tramadol dose within 72 hours postoperatively. Adverse reactions included nerve-block-related complications such as neuropathy, pneumothorax, intravascular injection, local anesthetic toxicity, as well as opioid-related complications such as pruritus, dizziness, postoperative nausea and vomiting.
Results: Seventy-nine patients were included, 40 patients in group LB and 39 patients in group B. Compared with group B, group LB had significantly lower AUCVAS at rest within 6-72 hours postoperatively, lower VAS pain scores at rest at 6, 24,48, and 72 hours postoperatively, lower rescue analgesia rate and postoperative nausea and vomiting incidence, longer time to first rescue analgesia, and reduced total tramadol use within 72 hours postoperatively (P < 0.05). No significant differences were found between the two groups in intraoperative remifentanil dose, estimated blood loss, fluid administration, or operative time.
Conclusion: Bupivacaine liposome combined with bupivacaine TTP-PECS Ⅱ block can provide long-term analgesia from intraoperative to postoperative 72 hours in modified radical mastectomy. |
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