术后镇痛：超声引导冷冻消融镇痛

本文由“小麻哥的日常"授权转载

🏌摘要译文(供参考)🏌

术前超声引导下经皮冷冻消融术治疗乳腺切除术后疼痛：

一项随机、参与者和观察者盲、空白对照研究

👉背景：

超声引导下经皮冷冻神经消融术是一种镇痛技术，其中使用经皮探针在极低温度下可逆地消融周围神经，尚未通过随机对照试验进行评估。

乳房切除术后疼痛可能难以治疗，作者假设，与仅接受标准护理治疗的患者相比，添加冷冻镇痛后，术后第2天手术相关疼痛的严重程度会更低。

👉方法：

术前，一个招募中心的参与者接受了0.5%罗哌卡因单次注射、T3或T4椎间神经阻滞和神经周围导管置管。参与者随后以随机、患者和观察者盲的方式对同侧T2至T5肋间神经进行了主动或假超声引导的经皮冷冻神经消融术。

所有参与者均接受0.2%罗哌卡因的持续椎旁阻滞，直到出院的清晨（通常是术后第2天）。

主要结局指标是术后第2天下午使用0-10数字评分量表测量的平均疼痛水平。

参与者随访1年。

👉结果：

术后第2天，接受冷冻神经消融术的参与者（n=31）的疼痛评分中位数为0[0-1.4]，而接受假手术的患者（n=29）的疼痛得分中位数为3.0[2.0-5.0]：差异-2.5（97.5%CI，-3.5-1.5），P<0.001。

有证据表明，在12个月内镇痛效果良好。

在前3周，冷冻神经消融术使阿片类药物的使用总量减少了98%，冷冻消融组使用1.5[0至14]mg羟考酮，而假手术组使用72[20至120]mg羟科酮（P<0.001）。

在1至12个月期间，任何患者均不需要口服止痛剂。

1年后，冷冻消融组组1例（3%）出现慢性疼痛，而假手术组5例（17%）出现慢性痛（P<0.0001）。

👉结论：

乳房切除术后经皮冷冻神经消融术显著改善了镇痛效果，无全身副作用或并发症。

🏌原文摘要🏌

Preoperative Ultrasound-guided Percutaneous Cryoneurolysis for the Treatment of Pain after Mastectomy:

A Randomized, Participant- and Observer-masked, Sham-controlled Study

👉Background:

Ultrasound-guided percutaneous cryoneurolysis is an analgesic technique in which a percutaneous probe is used to reversibly ablate a peripheral nerve(s) using exceptionally low temperature, and has yet to be evaluated with randomized, controlled trials.

Pain after mastectomy can be difficult to treat, and the authors hypothesized that the severity of surgically related pain would be lower on postoperative day 2 with the addition of cryoanalgesia compared with patients receiving solely standard-of-care treatment.

👉Methods:

Preoperatively, participants at one enrolling center received a single injection of ropivacaine, 0.5%, paravertebral nerve block at T3 or T4, and perineural catheter.

Participants subsequently underwent an active or sham ultrasound-guided percutaneous cryoneurolysis procedure of the ipsilateral T2 to T5 intercostal nerves in a randomized, patient- and observer-masked fashion.

Participants all received a continuous paravertebral block with ropivacaine, 0.2%, until the early morning of discharge (usually postoperative day 2).

The primary endpoint was the average pain level measured using a 0 to 10 numeric rating scale the afternoon of postoperative day 2. Participants were followed for 1 yr.

👉Results:

On postoperative day 2, participants who had received active cryoneurolysis (n = 31) had a median [interquartile range] pain score of 0 [0 to 1.4] versus 3.0 [2.0 to 5.0] in patients given sham (n = 29): difference -2.5 (97.5% CI, -3.5 to -1.5), P < 0.001.

There was evidence of superior analgesia through month 12.

During the first 3 weeks, cryoneurolysis lowered cumulative opioid use by 98%, with the active group using 1.5 [0 to 14] mg of oxycodone compared with 72 [20 to 120] mg in the sham group (P < 0.001).

No oral analgesics were required by any patient between months 1 and 12.

After 1 yr chronic pain had developed in 1 (3%) active compared with 5 (17%) sham participants (P < 0.001).

👉Conclusions:

Percutaneous cryoneurolysis markedly improved analgesia without systemic side effects or complications after mastectomy.