Application value of transversus thoracic muscle plane ⁃ pectoral nerves block under general anesthesia in patients with breast cancer
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摘要:
目的：评价胸横肌平面-胸神经（transversus thoracic muscle plane-pectoral nerves，TTP-PECS）阻滞用于减阿片类药物全麻下乳腺癌改良根治术中的安全性与可行性。方法：选择择期行乳腺癌改良根治术的患者60例，随机分为TTP-PECS阻滞联合减阿片药物全麻组（TO组）和常规全身麻醉组（GA组），每组30例。观察并记录两组患者各时点收缩压、舒张压、心率； 麻醉诱导前（T0）、插管前即刻（T1）、切皮时（T2）、切除乳腺标本时（T3）、手术结束时（T4）各时点安静及运动状态下的疼痛视觉模拟评分量表（visual analogue scale，VAS）；术后24 h 40项恢复质量评分量表（quality of recovery-40，QoR-40）评分；围术期不良反应的发生率。结果：与T0比较，两组患者T1~T4时点收缩压、舒张压、心率均显著降低（P < 0.05），但两组之间各时点收缩压、舒张压、心率比较差异无统计学意义（P > 0.05）；TO 组术后 2 h、6 h、12 h 安静及运动状态下 VAS 评分均显著低于 GA 组（P < 0.05）；TO组术后24 h QoR-40量表总评分及情绪状态、身体舒适度、心理支持、疼痛各项评分均显著高于GA组（P < 0.05）；TO 组患者诱导期咳嗽反射及术后恶心呕吐的发生率显著低于GA组（P < 0.05）。结论：TTP-PECS阻滞联合羟考酮-丙泊酚减阿片药物全身麻醉可安全用于乳腺癌改良根治术中，术后镇痛效果确切，降低术后恶心呕吐发生率，并能提高患者早期恢复质量。
Abstract:
Objective：To evaluate the safety and feasibility of transversus thoracic muscle plane-pectoral nerves（TTP-PECS）block in modified radical mastectomy for breast cancer under opioid-sparing general anesthesia. Methods：Sixty patients scheduled for modified radical mastectomy for breast cancer were randomly divided into two groups：the TTP-PECS block combined with opioid-sparing general anesthesia group（TO group）and the conventional general anesthesia group（GA group），with 30 patients in each group. The systolic blood pressure（SBP），diastolic blood pressure（DBP），and heart rate（HR）of the two groups were observed and recorded at various time points；the pain visual analogue scale（VAS）scores at rest and on movement were recorded at anesthesia induction（T0）， just before intubation（T1），at skin incision（T2），at breast specimen removal（T3），and at the end of surgery（T4）；and the quality of recovery-40（QoR-40）scores were assessed 24 h postoperatively. The incidence of adverse events during the perioperative period was also recorded. Results：Compared with T0，the SBP，DBP，and HR of both groups were significantly decreased at T1-T4（P < 0.05），but there was no statistically significant difference between the two groups at each time point（P > 0.05）. The VAS scores at 2 h，6 h，and 12 h postoperatively，both at rest and on movement，were significantly lower in the TO group than in the GA group（P < 0.05）. The total QoR -40 scores and scores for emotional state，physical comfort，psychological support，and pain were significantly higher in the TO group than in the GA group 24 h postoperatively（P < 0.05）. The incidence of cough reflex during induction and postoperative nausea and vomiting were significantly lower in the TO group than in the GA group（P < 0.05）. Conclusion：TTP-PECS block combined with opioid-sparing general anesthesia is safely used in modified radical mastectomy for breast cancer，providing effective postoperative analgesia，reducing the incidence of postoperative nausea and vomiting，and improving early recovery quality for patients.
