A Comparative Study of Bupivacaine Vs Ropivacaine Wound Instillation through Surgical Drain for Postoperative Analgesia in Modified Radical Mastectomy

Abstract

Introduction: Modified radical mastectomy (MRM) is associated with extensive tissue dissection and substantial postoperative pain. Various modes of postoperative analgesia have been used to alleviate the suffering of these patients. One of that is wound instillation, in our study we compared the effects of bupivacaine and ropivacaine for post-operative analgesia when instilled through the surgical drains in patients undergoing MRM. Material and methods: After obtaining the Institutional Ethics Committee approval and written informed consent, 60 female patients aged between 18 and 60 years with American Society of Anaesthesiologist status I/II scheduled to undergo MRM were enrolled for the study. Patients were randomised into two groups (30 each), a total of 40 cc of either bupivacaine (0.125%) or ropivacaine (0.2%) instilled through surgical drains. Visual analogue score and hemodynamics were compared in the postoperative period every 2 hourly till 12 hours. Quantitative data were compared by using unpaired t-test and qualitative data by using Chi-Square test and Fisher's Exact test. Results: Duration of analgesia was found to be significantly longer in bupivacaine group (512.37±63.06 minutes) as compared to ropivacaine (427.97±43.26 minutes) (p< 0.0001). Systolic and diastolic blood pressure were high and statistically significant in bupivacaine group as compared to ropivacaine but clinically not significant. Conclusion: Both local anaesthetics, bupivacaine and ropivacaine showed near similar pharmacological effects however the duration of analgesia was observed more with bupivacaine when instilled through the surgical drains. Wound instillation, being a non-invasive technique is an effective mode of providing postoperative analgesia in MRM as compare to other invasive modalities.

Postoperative Analgesia in Modified Radical Mastectomy Patients After Instillation of Bupivacaine Through Surgical Drains

“…We found that the mean time period of pain relief was much higher in Group B when compared to Group C (10.93±1.84 hours vs 5.03±1.35), supporting the hypothesis that there is a difference in the meantime period of analgesia in patients undergoing MRM with wound treated with bupivacaine. Our results are supported by Chhatrapati et al, with the duration of analgesia found to be much longer in their bupivacaine group with a p-value of <0.0001 [9]. Moreover, our study was better as we used 0.25% compared to the 0.125% strength of local anesthetic used in the former article.…”

“…Subsequently, the use of the analgesic drug was also reduced [18]. Likewise, Chhatrapati et al studied VAS in the postoperative period at one hour, 10 hours, and 12 hours and was found to show good pain relief in the bupivacaine group [9]. This supports our research as cumulative rescue analgesic consumption for pain relief in the first 24 hours with a pain score ≥6, which was significantly low in the bupivacaine group.…”

“…In addition to these, interventional techniques include local anesthetic infiltration and wound infusion with liposome bupivacaine. Regional anesthesia includes intercostal blocks, paravertebral blocks, thoracic epidural anesthesia, intrapleural blocks, and ultrasound-guided interfascial plane blocks [9].…”

A study to evaluate the efficacy of instillation of ropivacaine with fentanyl, dexmedetomidine, or morphine through surgical drain for post-operative analgesia in patients undergoing modified radical mastectomy

“…In their study, systolic and diastolic blood pressures were significantly higher in bupivacaine group than in ropivacaine group. 16 In a prospective study, Prieto et al, concluded the same efficacy of preventive treatment of pain for instillation or infiltration with 7.5% (20 mL) ropivacaine in patients after modified radical mastectomy and little need for rescue medication after surgery. 17…”

A Comparative Study of Placebo Versus Opioid-Free Analgesic Mixture for Mastectomies Performed Under General Anesthesia Along With Erector Spinae Plane Block

“…Opioids cause side effects such as opioid tolerance and dependence, postoperative headache, respiratory depression, nausea, pruritis, and urinary retention, and contribute to ileus. Other methods include wound infiltration and local anesthetic installation through surgical drain [ 3 , 4 ].…”