关键词: 胸横肌平面, 胸神经阻滞, 羟考酮, 丙泊酚, 全身麻醉, 乳腺癌

Abstract:

Objective To evaluate the efficacy and safety of the oxycodone-propofol opioid-sparing general anesthesia protocol， which is aided by transversus thoracic muscle plane-pectoral nerves （TTP-PECS） block， in patients undergoing breast-conserving surgery. Methods From September 2023 to August 2024， a total of 60 patients scheduled for breast-conserving surgery were enrolled and randomly allocated to either an opioid-sparing general anesthesia group （group TO， n = 30） or a conventional general anesthesia group （group GA， n = 30）. The mean arterial pressure （MAP） and heart rate （HR） at different time points were precisely recorded. The Numerical Rating Scale （NRS） scores at rest and during movement at 2， 6， 24， and 48 hours post-operatively were meticulously documented. For both groups， the number of patients who required rescue analgesia with flurbiprofen axetil within 48 hours post-operatively， as well as the time to the first request， was accurately recorded. The scores of the 15-item quality of recovery （QoR-15） scale were comprehensively assessed at 24 hours before and after surgery. The incidence of nerve block-related complications （e.g.， puncture site infection， bleeding， pneumothorax， local anesthetic systemic toxicity） in group TO and the number of patients who needed continuous remifentanil infusion were carefully observed. The two groups were also compared regarding the incidence of perioperative adverse events. Results Compared to group GA， group TO exhibited significantly lower MAP and HR at the intraoperative time points T2 and T3 （P < 0.05）. Postoperatively， group TO also had significantly lower NRS scores at rest and during movement， both at 2 hours and 6 hours （P < 0.05）. The rescue analgesia rate within 48 hours postoperatively was significantly lower in group TO than in group GA （P < 0.05）， and the time to first rescue analgesia was significantly later in group TO compared to group GA （P < 0.05）. The QoR-15 score at 24 hours postoperatively was significantly higher in group TO than in group GA （P < 0.05）. No complications related to trans-thoracic paravertebral-pectoral nerve block （TTP-PECS block）， such as puncture site infection， bleeding， pneumothorax， or local anesthetic toxicity， occurred in group TO， and none of the patients in group TO required additional continuous remifentanil infusion for analgesia. The incidence of cough reflex was significantly lower in group TO than in group GA （P < 0.05）. There were no statistically significant differences in the incidence of postoperative adverse events between the two groups （P > 0.05）. Conclusions The administration of TTP-PECS block during oxycodone-propofol opioid-sparing general anesthesia has demonstrated safety and efficacy in breast-conserving surgery. This technique obviates the requirement for intraoperative sufentanil or remifentanil， maintains stable hemodynamics， mitigates the stress response， effectively enhances perioperative analgesia， and improves the quality of early postoperative recovery.

Key words: transversus thoracic muscle plane, pectoral nerves block, oxycodone, propofol, general anesthesia, breast cancer