镇静、肋间神经阻滞和肿胀麻醉下美容乳房手术后的加速康复：早期术后阶段的前瞻性队列研究。
Enhanced Recovery After Aesthetic Breast Surgery Under Sedation, Intercostal Block and Tumescent Anaesthesia: A Prospective Cohort Study of the Early Postoperative Phase.
机构信息
CenterPlast Private Practice, Bahnhofstraße 36, 66111, Saarbrücken, Germany.
Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany.
出版信息
Aesthetic Plast Surg. 2023 Jun;47(3):979-997. doi: 10.1007/s00266-022-03214-w. Epub 2022 Dec 21.
BACKGROUND
Comfort and recovery are major concerns of patients seeking aesthetic surgery. This study aimed to assess postoperative pain and recovery after outpatient breast surgery under sedation, intercostal block, and local anaesthesia.
METHODS
This prospective cohort study included all consecutive patients who underwent aesthetic breast surgery between April 2021 and August 2022. Epidemiological data, anaesthesia, pain, and patients' satisfaction were systematically assessed with standardized self-assessment questionnaires.
RESULTS
Altogether, 48 patients [median (IQR) age: 30 (36-25)] were included. The most frequent surgery was mastopexy. 69% of surgeries involved additional procedures. The mean intercostal block and local anaesthesia time was 15 min. Patients received a median (IQR) of 19 (34-2) mg/kg lidocaine and 2.3 (2.5-2.0) mg/kg ropivacaine. The median (IQR) consumption of propofol and alfentanil was, respectively, 4.89 (5.48-4.26) mg/kg/h and 0.27 (0.39-0.19) µg/kg/min. No conversion to general anaesthesia or unplanned hospital admission occurred. Patients were discharged after a median (IQR) of 2:40 (3:43-1:58) hours. Within the first 24 postoperative hours, 17% required once an antiemetic medication and 38% an opioid. Patients were very satisfied with the anaesthesia and 90% of the patients had not wished more analgesia in the first 24 h.
CONCLUSIONS
Aesthetic breast surgery under sedation, intercostal block, and tumescent anaesthesia can safely be performed as an ambulatory procedure and is associated with minimal intra- and postoperative opioid consumption and high patient satisfaction. These data may be used to inform patients and clinicians and improve the overall quality of care.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
背景
舒适度和恢复是寻求美容手术的患者的主要关注点。本研究旨在评估门诊乳房手术在镇静、肋间阻滞和局部麻醉下的术后疼痛和恢复情况。
方法
这是一项前瞻性队列研究，纳入了 2021 年 4 月至 2022 年 8 月期间接受美容乳房手术的所有连续患者。使用标准化自我评估问卷系统地评估了流行病学数据、麻醉、疼痛和患者满意度。
结果
共纳入 48 例患者[中位数（IQR）年龄：30（36-25）]。最常见的手术是乳房上提术。69%的手术涉及附加手术。肋间阻滞和局部麻醉的平均时间为 15 分钟。患者接受的利多卡因中位数（IQR）为 19（34-2）mg/kg，罗哌卡因中位数（IQR）为 2.3（2.5-2.0）mg/kg。丙泊酚和阿芬太尼的中位（IQR）消耗量分别为 4.89（5.48-4.26）mg/kg/h 和 0.27（0.39-0.19）µg/kg/min。没有转为全身麻醉或计划外住院。患者中位（IQR）在术后 2：40（3：43-1：58）小时出院。在术后 24 小时内，17%的患者需要服用一次止吐药，38%的患者需要服用阿片类药物。患者对麻醉非常满意，90%的患者在术后 24 小时内不希望增加镇痛。
结论
镇静、肋间阻滞和肿胀麻醉下的美容乳房手术可安全地作为门诊手术进行，术中、术后阿片类药物的使用量少，患者满意度高。这些数据可用于为患者和临床医生提供信息，并提高整体护理质量。
证据水平 IV：本杂志要求作者为每篇文章指定一个证据水平。有关这些循证医学评级的完整描述，请参考目录或在线作者指南 www.springer.com/00266 。
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