胸横肌平面-胸神经阻滞辅助下羟考酮-丙泊酚少阿片全身麻醉在乳腺癌保乳手术中的有效性及安全性

doi:10.3969/j.issn.1006-5725.2026.05.002

Abstract

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

CLC Number:

R614

Zhengxia SUN,Lin ZHANG,Jiaqi CHANG,Hui XIE,Hui LIU,Qingming BIAN. Efficacy and safety of transversus thoracic muscle plane-pectoral nerve block combined with oxycodone-propofol opioid-sparing general anesthesia in breast-conserving surgery[J]. The Journal of Practical Medicine, 2026, 42(5): 734-741.

Figures/Tables 5

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Tab.2

Tab.3

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References 33

[1]	DE LA CRUZ KU G， KARAMCHANDANI M， CHAMBERGO-MICHILOT D， et al. Does Breast-Conserving Surgery with Radiotherapy have a Better Survival than Mastectomy？A Meta-Analysis of More than 1，500，000 Patients［J］. Ann Surg Oncol， 2022， 29（10）： 6163-6188. doi： 10.1245/s10434-022-12133-8 . doi: 10.1245/s10434-022-12133-8
[2]	CHEN C Y， CHEN Y. Better survival was found in patients treated with breast-conserving surgery compared with mastectomy in malignant phyllodes tumor of the breast［J］. Updates Surg， 2024， 76（1）： 265-270. doi： 10.1007/s13304-023-01547-y . doi: 10.1007/s13304-023-01547-y
[3]	LUO Y， CHEN X， LV R， et al. Breast-conserving surgery versus modified radical mastectomy in T1-2N3M0 stage breast cancer： A propensity score matching analysis［J］. Breast Cancer， 2024， 31（5）： 979-987. doi： 10.1007/s12282-024-01611-4 . doi: 10.1007/s12282-024-01611-4
[4]	LIAO Y H， LAI J N， HSU R J， et al. Breast‑conserving surgery with whole breast radiation therapy has a subsequent lower mood disorder incidence rate than total mastectomy in early‑stage breast cancer patients： A nationwide population‑based longitudinal study［J］. Breast Cancer Res Treat， 2022， 193（3）： 659-667. doi： 10.1007/s10549-022-06579-3 . doi: 10.1007/s10549-022-06579-3
[5]	王玉东，刘育贤，卞清明，等. 羟考酮联合丙泊酚用于乳腺癌保乳手术静脉全麻的临床效果评估［J］. 南京医科大学学报（自然科学版）， 2023， 43（12）： 1724-1728. doi： 10.7655/NYDXBNS20231217 . doi: 10.7655/NYDXBNS20231217
[6]	LI J， LYU Q， SU W， et al. A randomised trial： Effects of different anesthesia methods on early perioperative pain sensitivity and cellular immune function in patients undergoing radical mastectomy［J］. Gland Surg， 2021， 10（7）： 2246-2254. doi：10.21037/gs-21-343 . doi: 10.21037/gs-21-343
[7]	孙正秀，汪媛媛，林永傲，等. 经皮耳迷走神经刺激对胸腔镜肺切除术患者术后早期恢复质量的影响［J］. 实用医学杂志， 2025， 41（17）： 2670-2675. doi： 10.3969/j.issn.1006-5725. 2025.17.009 . doi: 10.3969/j.issn.1006-5725. 2025.17.009
[8]	吴春培，孙正霞，刘辉，等. 全身麻醉下胸横肌平面-胸神经阻滞在乳腺癌手术患者中的价值［J］. 南京医科大学学报（自然科学版）， 2024， 44（5）： 666-671. doi： 10.7655/NYDXBNSN231194 . doi: 10.7655/NYDXBNSN231194
[9]	BRAY F， LAVERSANNE M， SUNG H， et al. Global cancer statistics 2022： GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries ［J］. CA Cancer J Clin， 2024， 74（3）： 229-263. doi： 10.3322/caac.21834 . doi: 10.3322/caac.21834
[10]	URMAN R D， KHANNA A K， BERGESE S D， et al. Postoperative opioid administration characteristics associated with opioid-induced respiratory depression： Results from the PRODIGY trial［J］. J Clin Anesth， 2021， 70： 110167. doi： 10.1016/j.jclinane. 2021.110167 . doi: 10.1016/j.jclinane. 2021.110167
[11]	ORR J E， HILL D， OWENS R L. Opioids and Respiratory Related Consequences［J］. Sleep Med Clin， 2025， 20（4）： 499-507. doi： 10.1016/j.jsmc.2025.07.010 . doi: 10.1016/j.jsmc.2025.07.010
[12]	中国抗癌协会肿瘤整形外科专业委员会，中国抗癌协会肿瘤麻醉与镇痛专业委员会. 乳房再造加速康复外科中国专家共识（2022版）［J］. 中国肿瘤临床， 2023， 50（8）： 379-384. doi： 10.12354/j.issn.1000-8179.2023.20221437 . doi: 10.12354/j.issn.1000-8179.2023.20221437
[13]	LOMBANA N F， MEHTA I M， ZHENG C， et al. Updates on Enhanced Recovery after Surgery protocols for plastic surgery of the breast and future directions［J］. Proc （Bayl Univ Med Cent）， 2023， 36（4）： 501-509. doi： 10.1080/08998280.2023.2210036 . doi: 10.1080/08998280.2023.2210036
[14]	中华医学会麻醉学分会疼痛学组. 羟考酮注射液临床应用专家共识（2025版）［J］. 中华医学杂志，2025，105（44）： 4024-4040. doi： 10.3760/cma.j.cn112137-20250903-02286 . doi: 10.3760/cma.j.cn112137-20250903-02286
[15]	DIANA K， TEH M S， ISLAM T， et al. Benefits of PECS Block as Part of the Enhanced Recovery After Surgery （ERAS） Protocol for Breast Cancer Surgery in an Asian Institution： A Retrospective Cohort Study［J］. World J Surg， 2023， 47（3）： 564-572. doi： 10.1007/s00268-022-06881-7 . doi: 10.1007/s00268-022-06881-7
[16]	DOST B， BUGADA D， KARAPINAR Y E， et al. Paravertebral block is not superior to the interpectoral and pectoserratus plane block for patients undergoing breast surgery： An updated meta-analysis of randomised controlled trials with meta-regression and trial sequential analysis［J］. Eur J Anaesthesiol， 2025， 42（7）： 637-648. doi： 10.1097/EJA.0000000000002148 . doi: 10.1097/EJA.0000000000002148
[17]	ELJUGA D， MUŽAR R M， JURIŠIĆ I， et al. Regional anesthesia without opioid administration in mastectomy surgeries followed by breast reconstruction with implants： A randomized controlled study［J］. Croat Med J， 2025， 66（3）： 213-219. doi： 10.3325/cmj.2025.66.213 . doi: 10.3325/cmj.2025.66.213
[18]	BLANCO R， FAJARDO M， PARRAS MALDONADO T. Ultrasound description of Pecs Ⅱ （modified Pecs Ⅰ）： A novel approach to breast surgery［J］. Rev Esp Anestesiol Reanim， 2012， 59（9）： 470-475. doi： 10.1016/j.redar.2012.07.003 . doi: 10.1016/j.redar.2012.07.003
[19]	CONTI D， VALORIANI J， BALLO P， et al. The clinical impact of pectoral nerve block in an 'enhanced recovery after surgery' program in breast surgery［J］. Pain Manag， 2023， 13（10）： 585-592. doi： 10.2217/pmt-2023-0063 . doi: 10.2217/pmt-2023-0063
[20]	ZHANG X， JIA Y， CHOU C， et al. Comparative evaluation of PECS Ⅱ versus RISS block for postoperative analgesia in breast cancer surgery： A randomized controlled trial［J］. Am J Transl Res， 2025， 17（5）： 3971-3981. doi： 10.62347/CEED1530 . doi: 10.62347/CEED1530
[21]	ZHAO Y， JIN W， PAN P， et al. Ultrasound-guided transversus thoracic muscle plane-pectoral nerve block for postoperative analgesia after modifed radical mastectomy： A comparison with the thoracic paravertebral nerve block［J］. Perioper Med （Lond）， 2022， 11（1）： 1-11. doi： 10.1186/s13741-022-00270-3 . doi: 10.1186/s13741-022-00270-3
[22]	YANG G W， CHENG H， SONG X Y， et al. Effect of Oxycodone-Based Multimodal Analgesia on Visceral Pain After Major Laparoscopic Gastrointestinal Surgery： A Randomised， Double-Blind， Controlled Trial［J］. Drug Des Devel Ther， 2024， 18： 1799-1810. doi： 10.2147/DDDT.S464518 . doi: 10.2147/DDDT.S464518
[23]	HUANG Y， QIN F， LIAN Z， et al. Effect of multimodal preventive analgesia based on serratus anterior plane block and oxycodone on postoperative analgesia in elderly patients undergoing thoracoscopic lobectomy： A randomized controlled trial［J］. Sci Rep， 2025， 15（1）： 24459. doi： 10.1038/s41598-025-10117-8 . doi: 10.1038/s41598-025-10117-8
[24]	汤黎黎，孙月，刘学胜，等. 不同性别对日间关节镜手术患者瑞马唑仑使用剂量及术后恢复质量的影响［J］. 实用医学杂志， 2024， 40（8）： 1063-1068. doi： 10.3969/j.issn.1006-5725. 2024.08.007 . doi: 10.3969/j.issn.1006-5725. 2024.08.007
[25]	DE VLIEGER J C N， LUITING W H， LOCKYER J， et al. Validation of the Dutch translation of the quality of recovery-15 scale［J］. BMC Anesthesiol， 2022， 22（1）： 243. doi： 10.1186/s12871-022-01784-5 . doi: 10.1186/s12871-022-01784-5
[26]	BERGESTUEN L， MOGER T， OTERHALS K， et al. Translation and validation of the Norwegian version of the postoperative quality of recovery score QoR-15［J］. Acta Anaesthesiol Scand， 2024， 68（1）： 43-50. doi： 10.1111/aas.14322 . doi: 10.1111/aas.14322
[27]	LEE J H， KI M， CHOI S， et al. Validity and reliability of the Korean version of the Quality of Recovery-15 questionnaire［J］. Korean J Anesthesiol， 2021， 74（2）： 142-149. doi： 10.4097/kja. 20435 . doi: 10.4097/kja. 20435
[28]	NAKATANI S， IDA M， TANAKA Y， et al. Translation and validation of the Japanese Version of the Quality of Recovery-15 Questionnaire［J］. J Anesth， 2021， 35（3）： 426-433. doi： 10.1007/s00540-021-02921-z . doi: 10.1007/s00540-021-02921-z
[29]	LE BESCOND V， PETIT-PHAN J， CAMPFORT M， et al. Validation of the postoperative Quality of Recovery-15 questionnaire after emergency surgery and association with quality of life at three months［J］. Can J Anaesth， 2024， 71（5）： 590-599. doi： 10.1007/s12630-024-02722-4 . doi: 10.1007/s12630-024-02722-4
[30]	DEMUMIEUX F， LUDES P O， DIEMUNSCH P， et al. Validation of the translated Quality of Recovery-15 questionnaire in a French-speaking population［J］. Br J Anaesth， 2020， 124（6）： 761-767. doi： 10.1016/j.bja.2020.03.011 . doi: 10.1016/j.bja.2020.03.011
[31]	KARA U， ŞIMŞEK F， KAMBUROĞLU H， et al. Linguistic validation of a widely used recovery score： Quality of recovery-15 （QoR-15）［J］. Turk J Med Sci， 2022， 52（2）： 427-435. doi： 10.55730/1300-0144.5330 . doi: 10.55730/1300-0144.5330
[32]	MYLES P S， SHULMAN M A， REILLY J， et al. Measurement of quality of recovery after surgery using the 15-item quality of recovery scale： A systematic review and meta-analysis［J］. Br J Anaesth， 2022， 12（6）： 1029-1039. doi： 10.1016/j.bja. 2022. 03.009 . doi: 10.1016/j.bja. 2022. 03.009
[33]	卞清明，徐巧芳，许仄平，等. 不同剂量羟考酮预防全麻诱导时芬太尼诱发咳嗽的效果［J］. 中华麻醉学杂志， 2018， 38（7）： 800-802. doi：10.3760/oma.j.issn.0254-1416.2018.07.008 . doi: 10.3760/oma.j.issn.0254-1416.2018.07.008

指标	GA组（n = 30）	TO组（n = 30）	t/χ²值	P值
年龄/岁	44.4 ± 9.5	46.2 ± 8.0	-0.792	0.431
身高/cm	160.5 ± 5.4	158.9 ± 5.1	1.157	0.252
体质量/kg	56.4 ± 6.2	58.0 ± 8.0	-0.628	0.533
ASA分级/［例（%）］			0.317	0.573
Ⅰ级	8（26.7）	10（33.3）
Ⅱ级	22（73.3）	20（66.7）
手术时间/min	73.1 ± 12.9	78.2 ± 13.0	-1.532	0.131
丙泊酚消耗量/mg	361.2 ± 51.9	374.3 ± 50.9	-0.992	0.325
麻醉苏醒时间/min	13.4 ± 2.7	12.5 ± 3.3	1.195	0.237
拔管时间/min	16.8 ± 3.0	15.6 ± 3.2	1.425	0.160

组别	例数	MAP（x ± s）/mmHg					HR（x ± s）/（次/min）
组别	例数	T₀	T₁	T₂	T₃	T₄	T₀	T₁	T₂	T₃	T₄
GA组	30	95.4 ± 7.1	74.9 ± 3.7^*	89.1 ± 5.4^*	91.0 ± 5.6^*	82.1 ± 6.2^*	79.1 ± 7.5	65.6 ± 5.7^*	77.0 ± 7.6	79.7 ± 7.3	67.5 ± 6.9^*
TO组	30	94.0 ± 6.7	72.9 ± 4.8^*	84.6 ± 6.5^?#	86.7 ± 5.2^?#	79.7 ± 6.0^*	81.1 ± 8.1	63.9 ± 7.3^*	69.3 ± 6.3^?#	71.0 ± 8.3^?#	70.6 ± 6.3^*
t值		0.753	1.788	2.934	3.087	1.570	-0.990	1.050	4.293	5.254	-1.803
P值		0.454	0.079	0.005	0.003	0.122	0.326	0.298	< 0.001	< 0.001	0.077

组别	例数	安静状态				运动状态
组别	例数	术后2 h	术后6 h	术后24 h	术后48 h	术后2 h	术后6 h	术后24 h	术后48 h
GA组	30	2.2 ± 0.6	2.6 ± 0.7	2.3 ± 0.5	1.8 ± 0.6	2.9 ± 0.7	3.2 ± 1.0	2.7 ± 0.8	2.3 ± 0.5
TO组	30	1.9 ± 0.5	2.2 ± 0.7	2.0 ± 0.6	1.6 ± 0.5	2.3 ± 0.7	2.4 ± 0.6	2.4 ± 0.5	2.1 ± 0.6
t值		2.453	2.991	1.677	1.564	2.946	3.286	1.940	0.916
P值		0.017	0.004	0.099	0.123	0.005	0.002	0.058	0.364

组别	例数	术后躁动	恶心呕吐	皮肤瘙痒	术中低血压	诱导期咳嗽
GA组	30	1（3.3）	6（20.0）	3（10.0）	3（10.0）	6（20.0）
TO组	30	0（0.0）	2（6.7）	0（0.0）	5（16.7）	0（0.0）
χ²值			0.647	1.404	0.144	4.630
P值		> 0.999	0.421	0.236	0.704	0.031

Efficacy and safety of transversus thoracic muscle plane-pectoral nerve block combined with oxycodone-propofol opioid-sparing general anesthesia in breast-conserving surgery

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