Efektivita blokády pektorálneho nervu typu II oproti torakálnej paravertebrálnej blokáde v analgézii po operácii tumoru prsníka

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Autoři: Volodymyrovych Volodymyr Martsiniv ^1,2; Anatoliiovych Oleg Loskutov ¹; Mykolaiovych Andriy Strokan ^1,2; Mykolaiovych Maksim Pylypenko ¹; Volodymyrovych Mihailo Bondar ¹
Působiště autorů: Department of Anaesthesia and Intensive Care, P. L. Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine ¹; Department of Anaesthesia and Intensive Care, Feofaniya Clinical Hospital of State Management of Affairs, Kyiv, Ukraine ²
Vyšlo v časopise: Klin Onkol 2020; 33(4): 296-301
Kategorie: Původní práce
doi: https://doi.org/10.14735/amko2020296

Souhrn

Východiská: Ultrazvukom riadená blokáda pektorálneho nervu typu II je v súčasnosti používaná technika pooperačnej analgézie po operácii tumoru prsníka. Po desaťročia sa na tento účel využívala torakálna paravertebrálna blokáda. Táto práca ponúka porovnanie týchto dvoch spomenutých techník v manažmente pooperačnej analgézie.

Materiál a metódy: Šesťdesiat dospelých žien podstúpilo unilaterálnu radikálnu mastektómiu alebo kvadrantektómiu s axilárnou disekciou. Pacientkam (randomizované) bola vykonaná buď blokáda pektorálneho nervu s aplikáciou 30 ml ropivakaínu 0,375% (skupina Pecs) alebo torakálna paravertebrálna blokáda s aplikáciou ropivakaínu 20 ml 0,5% (skupina TPVB). Posudzované premenné boli intenzita bolesti po operácii, podľa numerickej hodnotiacej stupnice, po 0, 2, 4, 6, 12, 18 a 24 hodinách, 24-hodinová pooperačná spotreba opioidných analgetík (promedol) a neopioidov (ketoprofén) a časový interval po podaní prvého potrebného analgetika.

Výsledky: Neboli zistené žiadne štatisticky významné rozdiely v intenzite bolesti u pacientok po operácii. Desať pacientok (33%) zo skupiny Pecs a deväť pacientok (33%) zo skupiny TPVB nepožadovalo aplikáciu žiadneho analgetika počas prvých 24 hodín (p = 0,793). Priemerná spotreba ketoprofénu po operácii bola nižšia v skupine Pecs, a to 63,3 (± 66,87) mg oproti 90,0 (± 84,49) mg (p = 0,283). Počet pacientok, ktoré požadovali promedol bol 6 (20 %) v skupine Pecs a 8 (27 %) v skupine TPVB. Časový interval do podania prvého analgetika bol dlhší v skupine Pecs, tj. 550 (400,0–600,0) min, oproti skupine TPVB, tj. 510 (360,0–600,0) min (p = 0,506).

Záver: Blokáda pektorálneho nervu typu II po operácii tumoru prsníka s aplikáciou ropivakaínu 0,375% môže poskytnúť porovnateľnú pooperačnú analgéziu ako jednostupňová torakálna paravertebrálna blokáda.

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Klíčová slova:

torakálna paravertebrálna blokáda – blokáda pektorálneho nervu – chirurgia prsníka

Zdroje

The pectoral nerve block type II with ropivacaine 0.375% (Pecs block) provides efficacy which is comparable to the single-level thoracic paravertebral block (TPVB) analgesia during and after breast cancer surgery. These results allow considering this block as a good alternative to TPVB. Further larger studies are required to confirm these findings by reaching statistically significant evidence and to investigate the Pecs II effects on chronic pain development during a long-term period.

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