Effect of erector spinae plane block and thoracic epidural anesthesia on hospital length of stay and postoperative opioid use after mastectomy.

IF 3.2 2区医学 Q1 SURGERY Surgery Pub Date : 2024-10-31 DOI:10.1016/j.surg.2024.08.055

Nicolas Ajkay, Neal Bhutiani, Laura L Clark, Michelle Holland, Kelly M McMasters, Michael E Egger

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Abstract

Background: Adequate postoperative pain control is essential after mastectomy. This study compares the influence of 2 regional analgesia techniques on length of stay and opioid use to systemic analgesia alone.

Methods: Patients treated with mastectomy from 2014 to 2020 were stratified according to perioperative analgesic modality (systemic analgesia versus thoracic epidural anesthesia or erector spinae plane block). Demographic, tumor, and treatment characteristics were compared. Outcome variables included postoperative anesthesia unit and hospital length of stay, postoperative day 1 and 2 discharge rates, and inpatient opioid use (in oral milligram morphine equivalents).

Results: Of 316 patients, 171 received systemic analgesia, 72 thoracic epidural anesthesia, and 73 erector spinae plane block. On univariate analysis, there were significant differences in age, neoadjuvant chemotherapy, bilateral surgery, immediate reconstruction, and Her2 positivity rates. Thoracic epidural anesthesia had the longest hospital length of stay, and erector spinae plane block the shortest, compared with systemic analgesia (52.1 vs 28 vs 30.6 hours, P < .0001). Postoperative day 1 discharge was more likely with erector spinae plane block than systemic analgesia and less likely with thoracic epidural anesthesia (89% vs 68.4% vs 30.6%, P < .0001). Erector spinae plane block required significantly less milligram morphine equivalents than thoracic epidural anesthesia or systemic analgesia on postoperative day 1 (10 vs 18.75 vs 20 milligram morphine equivalents, P < .0009), but no differences on postoperative day 2 (23.5 vs 20 vs 25 milligram morphine equivalents, P = .84). Total hospital opioid use was significantly lower for erector spinae plane block than thoracic epidural anesthesia or systemic analgesia (24 vs 32.3 vs 32 milligram morphine equivalents, P = .024). On multivariate analysis, thoracic epidural anesthesia was associated with significantly longer length of stay, whereas neither thoracic epidural anesthesia nor erector spinae plane block was associated with decreased opioid use.

Conclusion: Regional analgesia is not significantly associated with decreased opioid use or hospital length of stay.

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竖脊肌平面阻滞和胸硬膜外麻醉对乳房切除术后住院时间和术后阿片类药物使用量的影响。

背景：乳房切除术后，充分的术后疼痛控制至关重要。本研究比较了两种区域镇痛技术与单纯全身镇痛对住院时间和阿片类药物使用量的影响：根据围手术期镇痛方式（全身镇痛与胸硬膜外麻醉或直立脊平面阻滞）对2014年至2020年接受乳房切除术治疗的患者进行分层。比较了人口统计学特征、肿瘤特征和治疗特征。结果变量包括术后麻醉科和住院时间、术后第1天和第2天出院率以及住院患者阿片类药物使用量（以口服毫克吗啡当量计）：316名患者中，171人接受了全身镇痛，72人接受了胸硬膜外麻醉，73人接受了竖脊平面阻滞。单变量分析显示，年龄、新辅助化疗、双侧手术、即刻重建和 Her2 阳性率存在显著差异。与全身镇痛相比，胸硬膜外麻醉的住院时间最长，直立脊平面阻滞的住院时间最短（52.1 小时 vs 28 小时 vs 30.6 小时，P < .0001）。与全身镇痛相比，直立脊平面阻滞术后第1天出院的可能性更大，而胸硬膜外麻醉的可能性较小（89% vs 68.4% vs 30.6%，P < .0001）。在术后第1天，脊柱后凸面阻滞所需的吗啡毫克当量明显少于胸硬膜外麻醉或全身镇痛（10 vs 18.75 vs 20毫克吗啡当量，P < .0009），但在术后第2天没有差异（23.5 vs 20 vs 25毫克吗啡当量，P = .84）。竖脊肌平面阻滞的住院阿片类药物总用量明显低于胸硬膜外麻醉或全身镇痛（24 vs 32.3 vs 32 毫克吗啡当量，P = .024）。多变量分析显示，胸硬膜外麻醉与住院时间明显延长有关，而胸硬膜外麻醉和直立脊平面阻滞均与阿片类药物用量减少无关：结论：区域镇痛与阿片类药物用量减少或住院时间延长无明显关系。

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

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.