Abstract：Objective: To evaluate the value of paravertebral catheter for threelevel injection via catheter using in modified radical mastectomy. Methods: A total of 40 patients were randomly divided into paravertebral block group(TPVB) and general anesthesia group(GA). TPVB group received paravertebral block via catheter and injections at three different levels combined with general anesthesia,while GA group using standard laryngeal mask general anesthesia.Acute and chronic pain VAS were recorded at the following observation points both at rest and movement, including discharging form postanesthesia care unit(PACU), 4 h, 8 h, 12 h(acute pain), 3 months and 6 months(chronic pain) after surgery.The amount of sufentanil during operation, the time of extubation and the incidence of nausea and vomiting at 24 h was also recorded.At 3 months and 6 months, the pain site, pain frequency and shortform McGill pain questionnaire(SFMPQ) were recorded. Results: ① Postoperative acute pain VAS:There was no significant difference at 4 h on movement and 8 h at rest after surgery between two groups(P＞0.05)，although TPVB groups VAS were significantly lower than that of the GA group in the rest of acute pain observation points(P<0.05); ② Compared with the GA group, TPVB groups sufentanil dosage, extubation time were reduced or shortened(P<0.05), but there was no significant difference in the incidence of nausea and vomiting at 24 h after surgery(P＞0.05); ③ Chronic pain VAS: Pain VAS at rest has no difference between two groups at 3 months after surgery(P＞0.05), and VAS of TPVB group was statistically lower than that of the GA group at 3 months and 6 months other observation points(P＜0.05); ④ postmastectomy pain syndrome（PMPS） incidence：There was no significant difference in the incidence of PMPS between the two groups at 3 and 6 months(P＞0.05); ⑤ SFMPQ:The score in TPVB group was statistically lower than that in GA group both at 3 and 6 months(P<0.05); ⑥ Correlation about chronic pain VAS:TPVB group:there was correlation between all acute pain and chronic pain VAS(P＜0.05),but 4 h and 8 hs was not correlated with that of 6 months(P＞0.05); GA group:the VAS score of perioperative observation points was all correlated with 3 months and 6 months. Conclusion: For modified radical mastectomy, paravertebral block via catheter and injections at three different levels not only can relieve the acute postoperative pain, reduce the dosage of sufentanil during operation, shorten the postoperative extubation time, but also significantly reduce the severity of PMPS, improve the quality of patients life. In addition, there is correlation between the VAS of acute pain and the chronic pain.
陈利， 孙彩霞. 经导管3个水平胸椎旁阻滞预防乳腺癌术后疼痛综合征的疗效观察[J]. 江苏大学学报:医学版, 2018, 28(01): 56-60,64.
CHEN Li, SUN Cai-xia. Paravertebral catheter for threelevel injection in radical mastectomy and its effects on post-mastectomy pain syndrome. Journal of Jiangsu University(Medicine Edition), 2018, 28(01): 56-60,64.
［1］Couceiro TC,Valena MM,Raposo MC,et al. Prevalence of postmastectomy pain syndrome and associated risk factors:a crosssectional cohort study\[J\]. Pain Manag Nurs, 2014,15(4):731-737.［2］Macdonald L,Bruce J,Scott NW,et al.Longterm followup of breast cancer survivors with postmastectomy pain syndrome\[J\]. Br J Cancer, 2005,92(2):225-230.［3］Shahbazi R, Akbari ME, Hashemian M,et al. High body mass index and young age are not associated with postmastectomy pain syndrome in breast cancer survivors:a casecontrol study\[J\]. Iran J Cancer Prev, 2015,8(1):29-35.［4］Wood K. Intercostobrachial nerve entrapment syndrome\[J\]. South Med J, 1978,71(6):662-663.［5］Karmakar MK, Samy W, Li JW, et al. Thoracic paravertebral block and its effects on chronic pain and healthrelated quality of life after modified radical mastectomy\[J\].Reg Anesth Pain Med,2014, 39(4):289-298.［6］Sundarathiti P, von Bormann B, Suvikapakornkul R,et al. Paravertebral catheter for threelevel injection in radical mastectomy:a randomized controlled study\[J\].PLoS One,2015,10(6):e0129539.［7］Wallace MS, Wallace AM, Lee J, et al. Pain after breast surgery:a survey of 282 women\[J\]. Pain, 1996,66(2/3):195-205.［8］WilderSmith OH. Chronic pain and surgery:a review of new insights from sensory testing\[J\]. J Pain Palliat Care Pharmacother, 2011,25(2):146-159.［9］Andreae MH, Andreae DA. Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery\[J\].Cochrane Database Syst Rev,2012,10:CD007105.［10］Choi SA, Son C, Lee JH, et al. Confirmatory factor analysis of the Korean version of the shortform McGill pain questionnaire with chronic pain patients: a comparison of alternative models\[J\]. Health Qual Life Outcomes, 2015,13:15.［11］Kojima KY, Kitahara M, Matoba M, et al. Survey on recognition of postmastectomy pain syndrome by breast specialist physician and present status of treatment in Japan\[J\].Breast Cancer,2014, 21(2):191-197.［12］Boezaart AP, Raw RW. Continuous thoracic paravertebral block for major breast surgery\[J\]. Reg Anesth Pain Med, 2006,31(5):470-476.［13］Schreiber KL, Martel MO, Shnol H, et al. Persistent pain in postmastectomy patients: comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain\[J\]. Pain,2013,154(5):660-668.［14］Kotake Y, Matsumoto M, Morisaki H, et al. The effectiveness of continuous epidural infusion of lowdose fentanyl and mepivacaine in perioperative analgesia and hemodynamic control in mastectomy patients\[J\]. J Clin Anesth,2004,16(2):88-91.［15］Kairaluoma PM, Bachmann MS, Korpinen AK, et al. Singleinjection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy\[J\]. Anesth Analg, 2004,99(6):1837-1843.［16］Naja MZ, Ziade MF, Lnnqvist PA. Nervestimulator guided paravertebral blockade vs. general anaesthesia for breast surgery:a prospective randomized trial\[J\].Eur J Anaesthesiol,2003,20(11): 897-903.［17］Lnnqvist PA, MacKenzie J, Soni AK,et al. Paravertebral blockade:Failure rate and complications\[J\]. Anaesthesia, 1995,50(9):813-815.［18］Naja Z,Lnnqvist PA.Somatic paravertebral nerve blockade.Incidence of failed block and complications\[J\]. Anaesthesia, 2001,56(12):1184-1188.［19］Eason MJ, Wyatt R.Paravertebral thoracic block: a reappraisal\[J\].Anaesthesia, 1979,34(7):638-642.
2018, Vol. 28 
