肉毒杆菌毒素注射用于乳房切除术后及乳房扩张器重建后的疼痛控制。
Botulinum toxin infiltration for pain control after mastectomy and expander reconstruction.
作者信息
Layeeque Rakhshanda, Hochberg Julio, Siegel Eric, Kunkel Kelly, Kepple Julie, Henry-Tillman Ronda S, Dunlap Melinda, Seibert John, Klimberg V Suzanne
机构信息
Department of Surgery, Division of Breast Surgical Oncology, University of Arkansas for Medical Sciences, Arkansas Cancer Research Center, and the Central Arkansas Veterans Hospital System, Little Rock, Arkansas, USA.
出版信息
Ann Surg. 2004 Oct;240(4):608-13; discussion 613-4. doi: 10.1097/01.sla.0000141156.56314.1f.
INTRODUCTION
We hypothesized botulinum toxin (BT) infiltration of the chest wall musculature after mastectomy would create a prolonged inhibition of muscle spasm and postoperative pain, facilitating tissue expander reconstruction.
METHODS
An Institutional Review Board (IRB)-approved prospective study was conducted of all patients undergoing mastectomy with tissue expander placement during a 2-year period. Study patients versus controls had 100 units of diluted BT injected into the pectoralis major, serratus anterior, and rectus abdominis insertion. Pain was scored using a visual analog scale of 0 to 10. Wilcoxon rank sum test was used for continuous variables and the chi2 test for nominal level data to test for significance.
RESULTS
Forty-eight patients were entered into the study; 22 (46%) with and 26 (54%) without BT infiltration. Groups were comparable in terms of age (55 +/- 11 years versus 52 +/- 10 years; P = 0.46), bilateral procedure (59% versus 61%; P = 0.86), tumor size (2 +/- 2 cm versus 2 +/- 3 cm; P = 0.4), expander size and volume (429 +/- 119 mL versus 510 +/- 138 mL; P = 0.5). The BT group did significantly better with pain postoperatively (score of 3 +/- 1 versus 7 +/- 2; P < 0.0001), during initial (score of 2 +/- 2 versus 6 +/- 3; P = 1.6 x 10(-6)), and final expansion (1 +/- 1 versus 3 +/- 2; P = 0.009). Volume of expansion per session was greater thus expansion sessions required less in the BT group (5 +/- 1 versus 7 +/- 3; P = 0.025). There was a significant increase in narcotic use in control patients in the first 24 hours (17 +/- 10 mg versus 3 +/- 3 mg; P < 0.0001), initial as well as final expansion periods (P = 0.0123 and 0.0367, respectively). One expander in the BT group versus 5 in the control group required removal (P = 0.13). There were no BT-related complications.
CONCLUSION
Muscular infiltration of botulinum toxin for mastectomy and tissue expander placement significantly reduced postoperative pain and discomfort without complications.
引言
我们假设乳房切除术后肉毒杆菌毒素（BT）注入胸壁肌肉组织会产生对肌肉痉挛和术后疼痛的长期抑制作用，从而便于组织扩张器重建。
方法
对在两年期间内所有接受乳房切除术并植入组织扩张器的患者进行了一项经机构审查委员会（IRB）批准的前瞻性研究。研究组患者与对照组患者在胸大肌、前锯肌和腹直肌附着处注射100单位稀释的BT。使用0至10的视觉模拟量表对疼痛进行评分。对连续变量采用Wilcoxon秩和检验，对名义水平数据采用卡方检验以检验显著性。
结果
48例患者纳入研究；22例（46%）接受BT注射，26例（54%）未接受。两组在年龄（55±11岁对52±10岁；P = 0.46）、双侧手术（59%对61%；P = 0.86）、肿瘤大小（2±2 cm对2±3 cm；P = 0.4）、扩张器大小和容量（429±119 mL对510±138 mL；P = 0.5）方面具有可比性。BT组术后疼痛情况显著更好（评分3±1对7±2；P < 0.0001），在初始扩张期（评分2±2对6±3；P = 1.6×10⁻⁶）和最终扩张期（1±1对3±2；P = 0.009）也是如此。BT组每次扩张的容量更大，因此所需的扩张次数更少（5±1对7±3；P = 0.025）。对照组患者在最初24小时（17±10 mg对3±3 mg；P < 0.0001）、初始扩张期和最终扩张期的麻醉药物使用量显著增加（分别为P = 0.0123和0.0367）。BT组有1个扩张器需要取出，而对照组有5个（P = 0.13）。未出现与BT相关的并发症。
结论
乳房切除术和组织扩张器植入时肌肉注射肉毒杆菌毒素可显著减轻术后疼痛和不适，且无并发症。
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