Comparison of continuous local anaesthetic and systemic pain treatment after axillary lymphadenectomy in breast carcinoma patients – a prospective randomized study

Abstract

BackgroundAcute pain after axillary lymphadenectomy is often related mainly to axillary surgery. The aim of the prospective randomized study was to find out if continuous wound infusion of local anaesthetic reduces postoperative pain, consumption of opioids and the incidence of chronic pain compared to the standard intravenous piritramide analgesia after axillary lymphadenectomy in breast carcinoma patients.MethodsAltogether 60 patients were enrolled in the prospective randomized study; half in wound infusion of local anaesthetic and half in the standard (piritramide) group.ResultsIn the recovery room and on the first day after surgical procedure, the wound infusion of local anaesthetic group reported less acute and chronic pain, a lower consumption of piritramide and metoclopramide, but their alertness after the surgical procedure was higher compared to the standard group.ConclusionsAfter axillary lymphadenectomy in breast carcinoma patients, wound infusion of local anaesthetic reduces acute pain and enables reduced opioid consumption, resulting in less postoperative sedation and a reduced need for antiemetic drugs. After wound infusion of local anaesthetic there is a statistical trend for reduction of chronic pain.

Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children

“…We grouped studies in broad categories (thoracotomy, cardiac surgery, breast surgery, caesarean section, laparotomy, and prostatectomy) with similar characteristics. We reported breast surgery (Albi-Feldzer 2013; Baudry 2008; Besic 2014; Fassoulaki 2000; Fassoulaki 2001; Fassoulaki 2005; Grigoras 2012; Ibarra 2011; Kairaluoma 2006; Karmakar 2014; Lee 2013; Micha 2012; Strazisar 2012; Strazisar 2014; Tecirli 2014; Terkawi 2015b) including cosmetic breast surgery (Bell 2001), in the same subgroup, but performed a sensitivity analysis excluding plastic surgery.…”

“…For laparotomy surgery, both studies employed epidural anaesthesia (Katz 2004; Lavand’homme 2005), whereas in hysterectomy both studies employed spinal anaesthesia (Sprung 2006; Wodlin 2011). Within the other surgical subgroups, studies investigated different regional anaesthetic techniques: for breast surgery, mostly paravertebral block (Gacio 2016; Ibarra 2011; Kairaluoma 2006; Karmakar 2014; Lam 2015; Lee 2013), with and without some local infiltration (Albi-Feldzer 2013), some used intravenous local anaesthesia (Grigoras 2012; Terkawi 2015b), others used only local infiltration (Baudry 2008; Besic 2014; Strazisar 2012; Strazisar 2014); for caesarean section, mostly transverse abdominal plain block (Bollag 2012; Loane 2012; McKeen 2014; Singh 2013), and peritoneal instillation (Shahin 2010); for hernia repair, mainly local/wound infiltration.…”

Postmastectomy Pain Syndrome

“…Other risk factors include prior history of headache, being younger than 50 years old (especially 35 years old), genetic sensibility, psychosocial situation, marital status, employment status, housing, presence of post-operative pain, smoking, and presence of pain during peri-operative period (23)(24)(25). It seems that tumor in younger patients is negative estrogen-response and high grade.…”

“…It is recommended that acute pain should be appropriately managed to decrease post-operative chronic pain (10). Strazisar et al addressed the role of acute pain in post-operative chronic pain and showed positive impact of continuous infusion of local anesthetic by placing catheter on mastectomy surgery incision site (24). Moreover, Fassoulaki et al demonstrated that in patients undergoing mastectomy or lumpectomy in combination with axillary lymph node dissection, in which eutectic mixture of local anesthetic (EMLA) was used during pre-operative period for 3 days after surgery, chronic pain occurrence may be reduced 3 months after operation (29).…”

Difficult airway research options and ethical consensus – a reply

“…Firstly, the meta-analysis included only randomised controlled trials comparing the effect of PVB to sham or no block on PPP. However, Ilfeld et al [4] compared single-shot and continuous PVB, and reported that 'all patients received a single injection of long-acting local anesthetic (15 ml of ropivacaine 0.5%, with epinephrine 5 lg.ml Secondly, the trial by Chui et al [5], who compared PVB with local infiltration analgesia, also lacked a control group, local infiltration itself being an effective intervention in preventing chronic pain following breast cancer surgery [6][7][8], and so should have also been excluded from the meta-analysis.…”