Intrathecal Morphine vs Paravertebral Nerve Blocks for Analgesia After Breast Reconstruction With Abdominally Based Free Flaps.

IF 3 2区医学 Q1 SURGERY

Aesthetic Surgery Journal Pub Date : 2025-05-15 DOI:10.1093/asj/sjaf043

Matthew W Swisher, Austin T Nguyen, Miriam Becker, Jacklynn F Sztain, Wendy B Abramson, Paige S Tsuda, Brenton S Alexander, Chris M Reid, Engy T Said

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引用次数: 0

Abstract

Background: Breast reconstruction with abdominally based free flaps can be associated with more significant acute pain and longer hospital stays than implant-based techniques. As new pain management strategies are developed, there have not been any studies conducted to analyze the analgesic effects of intrathecal morphine (ITM) for patients undergoing abdominally based free flap reconstruction.

Objectives: The primary outcome analyzed in this retrospective study was opioid consumption, which was measured from the postoperative anesthesia care unit (PACU) through postoperative day (POD) 2. Secondary outcomes of the study analyzed included factors such as pain scores, hospital length of stay (LOS), and adverse effects.

Methods: Fifty-one patients presented for breast reconstruction with abdominally based free flaps and received ITM for postoperative analgesia. Results obtained were compared with a cohort that included an equal number of patients who received paravertebral nerve blocks (PVBs).

Results: Results showed that patients who received ITM displayed a lower median consumption in the PACU (0 mg vs 12.5 mg MEQ; P = .009), from PACU to POD 1 (0 mg vs 7.5 mg MEQ; P = .046), and POD 1 to POD 2 (7.5 mg vs 30 mg MEQ; P = .002) when compared with those who received PVBs. Those who received ITM also had lower median pain scores in the PACU and from PACU to POD 1 and a decreased LOS. There were similar rates of adverse events.

Conclusions: ITM improves postoperative analgesia after abdominally based free flaps when compared to PVBs and may facilitate recovery and earlier discharge.

Level of evidence: 3:

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鞘内吗啡与椎旁神经阻滞对腹部游离皮瓣乳房再造术后镇痛的影响。

背景：与基于植入的技术相比，基于腹部的游离皮瓣乳房重建可能会导致更严重的急性疼痛和更长的住院时间。随着新的疼痛管理策略的发展，尚无研究分析鞘内吗啡（ITM）对腹部游离皮瓣重建患者的镇痛效果。目的：本回顾性研究分析的主要结局是阿片类药物的消耗，从术后麻醉护理单位（PACU）到术后一天（POD） 2。此外，研究分析的次要结局包括疼痛评分、住院时间（LOS）和不良反应等因素。方法：51例患者行腹侧游离皮瓣乳房再造术，术后行ITM镇痛。然后，将获得的结果与包括相同数量接受椎旁神经阻滞（pvb）的患者的队列进行比较。结果：结果显示，接受ITM治疗的患者PACU的中位用量较低(0 mg vs 12.5 mg MEQ；p = 0.009)，从PACU到POD 1 (0 mg vs . 7.5 mg MEQ；p =0.046)， POD 1对POD 2 (7.5 mg vs 30 mg MEQ；p = 0.002)。接受ITM治疗的患者在PACU和从PACU到POD 1的中位疼痛评分也较低，并且LOS降低。不良事件发生率相似。结论：与pvb相比，ITM可改善腹部游离皮瓣术后镇痛，并可促进恢复和早期出院。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Aesthetic Surgery Journal SURGERY-

CiteScore

6.20

自引率

20.70%

发文量

309

审稿时长

6-12 weeks

期刊介绍： Aesthetic Surgery Journal is a peer-reviewed international journal focusing on scientific developments and clinical techniques in aesthetic surgery. The official publication of The Aesthetic Society, ASJ is also the official English-language journal of many major international societies of plastic, aesthetic and reconstructive surgery representing South America, Central America, Europe, Asia, and the Middle East. It is also the official journal of the British Association of Aesthetic Plastic Surgeons, the Canadian Society for Aesthetic Plastic Surgery and The Rhinoplasty Society.