椎旁平面阻滞在乳腺癌手术中的应用进展
Application Progress of Paravertebral Plane Block in Breast Cancer Surgery
DOI: 10.12677/acm.2024.1492425, PDF,   
作者: 谢海龙*, 黄大元：吉首大学医学院研究生部，湖南 吉首；伍国芳：娄底市中心医院麻醉科，湖南 娄底
关键词: 椎旁间隙阻滞；胸椎旁阻滞；乳腺；区域阻滞；镇痛；Paravertebral Space Block； Thoracic Paravertebral Block； The Mammary Gland； Regional Block； Analgesia
摘要: 超声引导下的神经阻滞技术在乳腺癌围术期镇痛中承担着重要角色，在众多的阻滞技术中胸椎旁阻滞技术因镇痛效果确切，常作为金标准被各指南推荐。为降低胸椎旁阻滞的风险以及操作难度，竖脊肌平面阻滞、肋横突阻滞、横突–胸膜中点阻滞、椎板阻滞等椎旁平面阻滞技术被陆续开发并应用于临床，文章介绍了上述椎旁平面阻滞技术及其在乳腺手术当中的应用情况，这些阻滞技术操作相对简单，但镇痛效果、药物扩散途径及相关风险目前存在争议，需要进一步研究。
Abstract: Ultrasound-guided nerve block plays an important role in the perioperative analgesia of breast cancer. Among many block techniques, thoracic paravertebral block is often recommended as the gold standard by various guidelines because of its exact analgesic effect. In order to reduce the risk of thoracic paravertebral block and the difficulty of operation, paravertebral block techniques such as erector spinae plane block, costotransverse process block, transverse process-pleural point block, and laminar block have been developed and applied in clinical practice. This article introduces the above paravertebral plane block techniques and their application in breast surgery. But the analgesia effect, way of drug diffusion and related risk is controversial, needs further research.
文章引用：谢海龙, 伍国芳, 黄大元. 椎旁平面阻滞在乳腺癌手术中的应用进展[J]. 临床医学进展, 2024, 14(9): 40-45. https://doi.org/10.12677/acm.2024.1492425

参考文献

[1] 何思怡, 李贺, 曹毛毛, 等. 全球及我国女性乳腺癌疾病负担年龄分布及变化趋势[J]. 中国肿瘤, 2023, 32(1): 1-7.
[2] 中华医学会外科学分会乳腺外科学组. 中国乳腺癌改良根治术临床实践指南(2022版) [J]. 中国实用外科杂志, 2022, 42(2): 128-131.
[3] Khan, J.S., Ladha, K.S., Abdallah, F. and Clarke, H. (2019) Treating Persistent Pain after Breast Cancer Surgery. Drugs, 80, 23-31. [Google Scholar] [CrossRef] [PubMed]
[4] Jacobs, A., Lemoine, A., Joshi, G.P., Van de Velde, M. and Bonnet, F. (2020) Prospect Guideline for Oncological Breast Surgery: A Systematic Review and Procedure-Specific Postoperative Pain Management Recommendations. Anaesthesia, 75, 664-673. [Google Scholar] [CrossRef] [PubMed]
[5] Krediet, A.C., Moayeri, N., van Geffen, G., Bruhn, J., Renes, S., Bigeleisen, P.E., et al. (2015) Different Approaches to Ultrasound-Guided Thoracic Paravertebral Block. Anesthesiology, 123, 459-474. [Google Scholar] [CrossRef] [PubMed]
[6] 冉茂琳, 于布为, 薛庆生. 胸椎旁神经阻滞严重并发症——全脊麻[J]. 临床麻醉学杂志, 2019, 35(12): 1234-1236.
[7] Pfeiffer, G., Oppitz, N., Schöne, S., Richter-Heine, I., Höhne, M. and Koltermann, C. (2006) Analgesie der Achselhöhle durch Paravertebralkatheter in Laminatechnik. Der Anaesthesist, 55, 423-427. [Google Scholar] [CrossRef] [PubMed]
[8] Zeballos, J.L., Voscopoulos, C., Kapottos, M., Janfaza, D. and Vlassakov, K. (2013) Ultrasound-Guided Retrolaminar Paravertebral Block. Anaesthesia, 68, 649-651. [Google Scholar] [CrossRef] [PubMed]
[9] Murouchi, T. and Yamakage, M. (2016) Retrolaminar Block: Analgesic Efficacy and Safety Evaluation. Journal of Anesthesia, 30, 1003-1007. [Google Scholar] [CrossRef] [PubMed]
[10] Aoki, H., Terao, Y., Fujimoto, E., Oji, M., Oji, N., Iwanaga, H., et al. (2023) Multiple-Level Retrolaminar Block Can Provide Effective Analgesia in Nipple-Sparing Mastectomy with Latissimus Dorsi Flap Reconstruction: A Report of Two Cases. Journal of Advances in Medicine and Medical Research, 35, 54-59. [Google Scholar] [CrossRef] 
[11] Hwang, B., Kim, E., Kwon, J., Lee, J., Lee, D., Park, E.J., et al. (2020) The Analgesic Efficacy of a Single Injection of Ultrasound-Guided Retrolaminar Paravertebral Block for Breast Surgery: A Prospective, Randomized, Double-Blinded Study. The Korean Journal of Pain, 33, 378-385. [Google Scholar] [CrossRef] [PubMed]
[12] Onishi, E., Murakami, M., Nishino, R., Ohba, R. and Yamauchi, M. (2018) Analgesic Effect of Double-Level Retrolaminar Paravertebral Block for Breast Cancer Surgery in the Early Postoperative Period: A Placebo-Controlled, Randomized Clinical Trial. The Tohoku Journal of Experimental Medicine, 245, 179-185. [Google Scholar] [CrossRef] [PubMed]
[13] Adhikary, S.D., Bernard, S., Lopez, H. and Chin, K.J. (2018) Erector Spinae Plane Block versus Retrolaminar Block. Regional Anesthesia and Pain Medicine, 43, 756-762. [Google Scholar] [CrossRef] [PubMed]
[14] 黄亮亮, 曾繁军, 陈志明, 等. 超声引导下椎板后阻滞的临床应用研究进展[J]. 现代医药卫生, 2022, 38(21): 3698-3701.
[15] Damjanovska, M., Stopar Pintaric, T., Cvetko, E. and Vlassakov, K. (2018) The Ultrasound-Guided Retrolaminar Block: Volume-Dependent Injectate Distribution. Journal of Pain Research, 11, 293-299. [Google Scholar] [CrossRef] [PubMed]
[16] Forero, M., Adhikary, S.D., Lopez, H., Tsui, C. and Chin, K.J. (2016) The Erector Spinae Plane Block. Regional Anesthesia and Pain Medicine, 41, 621-627. [Google Scholar] [CrossRef] [PubMed]
[17] Ben Amor, M., Ben Marzouk, S., Souihli, S., et al. (2023) Postoperative Analgesia in Breast Cancer Surgery: Efficiency and Safety of Ultrasound Guided Erector Spinae Plane Block, a Randomized Controlled Double Blinded Trial. La Tunisie Médicale, 101, 559-563.
[18] Tunay, D.L., Ilginel, M.T., Karacaer, F., Biricik, E., Tabakan, I. and Ozmete, O. (2023) Bilateral Ultrasound-Guided Erector Spinae Plane Block for Perioperative Analgesia in Breast Reduction Surgery: A Prospective Randomized and Controlled Trial. Aesthetic Plastic Surgery, 47, 1279-1288. [Google Scholar] [CrossRef] [PubMed]
[19] Mohsin, M.H., Verma, R., Singh, D., et al. (2022) Effect of Erector Spinae Block and PECS Block on Quality of Recovery and Analgesia after Modified Radical Mastectomy. Sultan Qaboos University Medical Journal, 23, 220-226. [Google Scholar] [CrossRef] [PubMed]
[20] Jethava, D., Malawat, A., Verma, K. and Jethava, D. (2020) Erector Spinae Plane Block for Complete Surgical Anaesthesia and Postoperative Analgesia for Breast Surgeries: A Prospective Feasibility Study of 30 Cases. Indian Journal of Anaesthesia, 64, 118-124. [Google Scholar] [CrossRef] [PubMed]
[21] Guan, H., Yuan, Y., Gao, K. and Luo, H. (2023) Efficacy and Safety of Erector Spinae Plane Block for Postoperative Analgesia in Breast Cancer Surgery—A Systematic Review and Meta-Analysis. Journal of Surgical Oncology, 127, 905-920. [Google Scholar] [CrossRef] [PubMed]
[22] Liu, Y. (2021) Erector Spinae Plane Block Similar to Paravertebral Block for Perioperative Pain Control in Breast Surgery: A Meta-Analysis Study. Pain Physician, 24, 203-213. [Google Scholar] [CrossRef] 
[23] Chen, W., Zhou, X., Li, H., Liu, B., Wang, L., Liu, T., et al. (2023) Analgesic Effectiveness of Preoperative Ultrasound-Guided Erector Spinae Plane Block versus Paravertebral Nerve Block for Breast Surgery: A Systematic Review and Meta-Analysis of Four Randomized Controlled Trials. Pain Practice, 23, 511-522. [Google Scholar] [CrossRef] [PubMed]
[24] Sivrikoz, N., Turhan, Ö., Ali, A., Altun, D., Tükenmez, M. and Sungur, Z. (2022) Paravertebral Block versus Erector Spinae Plane Block for Analgesia in Modified Radical Mastectomy: A Randomized, Prospective, Double-Blind Study. Minerva Anestesiologica, 88, 1003-1012. [Google Scholar] [CrossRef] [PubMed]
[25] Premachandra, A., Wang, X., Saad, M., Moussawy, S., Rouzier, R., Latouche, A., et al. (2022) Erector Spinae Plane Block versus Thoracic Paravertebral Block for the Prevention of Acute Postsurgical Pain in Breast Cancer Surgery: A Prospective Observational Study Compared with a Propensity Score-Matched Historical Cohort. PLOS ONE, 17, e0279648. [Google Scholar] [CrossRef] [PubMed]
[26] Leong, R.W., Tan, E.S.J., Wong, S.N., Tan, K.H. and Liu, C.W. (2020) Efficacy of Erector Spinae Plane Block for Analgesia in Breast Surgery: A Systematic Review and Meta-Analysis. Anaesthesia, 76, 404-413. [Google Scholar] [CrossRef] [PubMed]
[27] Choi, Y., Kwon, H., O, J., Cho, T., Won, J.Y., Yang, H., et al. (2019) Influence of Injectate Volume on Paravertebral Spread in Erector Spinae Plane Block: An Endoscopic and Anatomical Evaluation. PLOS ONE, 14, e0224487. [Google Scholar] [CrossRef] [PubMed]
[28] Tulgar, S., Ahiskalioglu, A., de Cassai, A. and Gurkan, Y. (2019) Efficacy of Bilateral Erector Spinae Plane Block in the Management of Pain: Current Insights. Journal of Pain Research, 12, 2597-2613. [Google Scholar] [CrossRef] [PubMed]
[29] Ivanusic, J., Konishi, Y. and Barrington, M.J. (2018) A Cadaveric Study Investigating the Mechanism of Action of Erector Spinae Blockade. Regional Anesthesia and Pain Medicine, 43, 567-571. [Google Scholar] [CrossRef] [PubMed]
[30] Schwartzmann, A., Peng, P., Maciel, M.A., Alcarraz, P., Gonzalez, X. and Forero, M. (2020) A Magnetic Resonance Imaging Study of Local Anesthetic Spread in Patients Receiving an Erector Spinae Plane Block. Canadian Journal of Anesthesia, 67, 942-948. [Google Scholar] [CrossRef] [PubMed]
[31] Yang, H.-M., Choi, Y.J., Kwon, H.-J., et al. (2018) Comparison of Injectate Spread and Nerve Involvement between Retrolaminar and Erector Spinae Plane Blocks in the Thoracic Region: A Cadaveric Study. Anaesthesia, 73, 1244-1250. [Google Scholar] [CrossRef] [PubMed]
[32] Costache, I., de Neumann, L., Ramnanan, C.J., Goodwin, S.L., Pawa, A., Abdallah, F.W., et al. (2017) The Mid-Point Transverse Process to Pleura (MTP) Block: A New End-Point for Thoracic Paravertebral Block. Anaesthesia, 72, 1230-1236. [Google Scholar] [CrossRef] [PubMed]
[33] Scimia, P., Fusco, P., Droghetti, A., Harizaj, F. and Basso Ricci, E. (2018) The Ultrasound-Guided Mid-Point Transverse Process to Pleura Block for Postoperative Analgesia in Video-Assisted Thoracoscopic Surgery. Minerva Anestesiologica, 84, 767-768. [Google Scholar] [CrossRef] [PubMed]
[34] Kahramanlar, A.A., Aksoy, M., Ince, I., Dostbıl, A. and Karadenız, E. (2022) The Comparison of Postoperative Analgesic Efficacy of Ultrasound-Guided Paravertebral Block and Mid-Point Transverse Process Pleura Block in Mastectomy Surgeries: A Randomized Study. Journal of Investigative Surgery, 35, 1694-1699. [Google Scholar] [CrossRef] [PubMed]
[35] Costache, I. (2019) Mid-Point Transverse Process to Pleura Block for Surgical Anaesthesia. Anaesthesia Reports, 7, 1-3. [Google Scholar] [CrossRef] [PubMed]
[36] Nielsen, M.V., Moriggl, B., Hoermann, R., Nielsen, T.D., Bendtsen, T.F. and Børglum, J. (2019) Are Single-Injection Erector Spinae Plane Block and Multiple-Injection Costotransverse Block Equivalent to Thoracic Paravertebral Block? Acta Anaesthesiologica Scandinavica, 63, 1231-1238. [Google Scholar] [CrossRef] [PubMed]
[37] Kampitak, W. (2020) The Novel Costotransverse Foramen Block Technique: Distribution Characteristics of Injectate Compared with Erector Spinae Plane Block. Pain Physician, 3, E305-E314. [Google Scholar] [CrossRef] 
[38] Aygun, H., Thomas, D.T. and Nart, A. (2020) Ultrasound Guided Single Injection Costotransverse Block in a Breast Conserving Surgery Patient; The First Clinical Report for Novel Interfascial Block. Journal of Clinical Anesthesia, 61, Article 109647. [Google Scholar] [CrossRef] [PubMed]
[39] Pangasa, N., Nanda, S., Bhoi, D. and Jain, D. (2021) Multiple Injection Costotransverse Block for Chronic Pain in a Patient with Granulomatous Mastitis. Indian Journal of Anaesthesia, 65, 772-774. [Google Scholar] [CrossRef] [PubMed]
[40] Sethuraman, R.M. (2024) Costotransverse Block versus Costotransverse Foramen Block: Long Way to Clarity on the Difference in Anatomy and Techniques. Saudi Journal of Anaesthesia, 18, 3-5. [Google Scholar] [CrossRef] [PubMed]

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