Multimodal Pain Management in Autologous Tissue-Based Breast Reconstruction with Deep Inferior Epigastric Perforator Flap

利用深下腹動脈穿通枝皮瓣進行自體乳房重建的多重模式疼痛控制

Chih-Chao Chuang(莊智超) ； Wei-Nung Teng(鄧惟濃) ； Cherng-Kang Perng(彭成康) ； Ling-Ming Tseng(曾令民) ； Yi-Fang Tsai(蔡宜芳) ； Yen-Shu Lin(林燕淑) ； Fu-Yin Hsiao(蕭福尹) ； Feng Chin-Jung(馮晉榮)

《臺灣整形外科醫學會雜誌》 32卷2期 (2023/06) Pp. 97-110

摘要

Background: The prevalence of breast cancer is gradually increasing. Postoperative reconstruction improves the appearance of the breast. Autologous tissue-based breast reconstruction has been associated with higher postoperative satisfaction and psychosocial well-being. However, it requires a longer operation time and hospital stay. Prominent wound pain is also a concern. Aim and Objectives: This study aimed to compare the outcomes of patients undergoing autologous tissue-based reconstruction with deep inferior epigastric perforator (DIEP) flap before and after the implementation of a multimodal pain control program. Materials and Methods: This retrospective study included 79 patients with breast cancer who underwent autologous tissue-based breast reconstruction with DIEP flap between October 2015 and June 2021. Patient demographics and intraoperative and postoperative variables were collected from patients' medical records. The primary endpoints were hospital length of stay (LOS) and total postoperative opioid consumption. Results: A total of 78 consecutive patients were included and analyzed (traditional recovery after surgery group, n=46; enhanced recovery after surgery group [ERAS], n=32). The mean hospital LOS (10.3 days vs. 10.2 days, p=0.557) and Visual Analog Scale scores were not significantly different. The total postoperative intravenous morphine equivalent consumption was lower in the ERAS group (119 mg vs. 28.7 mg, p<0.001). The overall postoperative complications showed no significant differences (p=0.952). Conclusion: The incorporation of multimodal pain management for autologous tissue-based breast reconstruction with DIEP flap decreased opioid consumption to achieve comparable pain control without additional postoperative complications.

關鍵字

breast reconstruction ； enhanced recovery after surgery ； multimodal pain management ； regional block ； quadratus lumborum block

並列摘要

背景：由於乳癌的盛行率逐漸增加，因此術後重建的需求也增加，重建可以再現乳房原來的外觀，比起異體植入，使用自體組織術後有更高的滿意度以及更好的精神社會狀況。然而，自體組織需要更長的手術以及住院時間，另外，術後的疼痛也是必須考慮的重要問題。目的及目標：此篇研究是比較利用深下腹動脈穿通枝皮瓣來進行乳房重建的病人，使用多重疼痛控制之前和之後，評估其術後的結果。材料及方法：回溯2015年10月至2021年6月期間，診斷為乳癌並於本院接受深下腹動脈穿通枝皮瓣進行乳房重建的病人，從病歷搜集病人之基本資訊、手術和術後的相關資料。主要的研究結束點是住院時間的長短和術後使用鴉片類藥物的總量。結果：研究總共收錄78位病人，其中46位為術後傳統康復療程，另外32位為術後加速康復療程，兩組病人在平均住院時間（10.3天和10.2天，p=0.577）和疼痛視覺類比量表（Visual Analogue Scale）沒有差異，但術後加速康復療程的病人，術後使用鴉片類藥物的總量顯著減少（119 mg 和28.7 mg，p<0.001），術後併發症也沒有顯著的差異。結論：接受深下腹動脈穿通枝皮瓣進行乳房重建的病人，在住院期間依據多重疼痛控制的原則，可以有效得減少鴉片類藥物的總量，達到一樣有效的疼痛控制，且沒有額外的術後併發症。