Regional block and mexiletine: The effect on pain after cancer breast surgery

Fassoulaki, Argyro; Sarantopoulos, Constantine; Melemeni, Aikaterini; Hogan, Quinn H.

doi:10.1053/rapm.2001.23205

Cited by 30 publications

(48 citation statements)

References 10 publications

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“…For CPSP, local anesthetics may have clinical utility through early interruption of sensory information to the dorsal horn of the spinal cord [60]. The analgesic action from local anesthetics is based on the suppression of abnormal sodium channels that exist along injured neurons via cellular mechanisms such as the inhibition of G proteincoupled receptors and NMDA receptors [61,62].…”

Section: Local Anestheticsmentioning

confidence: 99%

“…Patients randomized to IV lidocaine were found to have significantly lower pain scores, with fewer patients developing CPSP (2/17 patients) or secondary hyperalgesia compared to patients randomized into the placebo group (9/ 19) at 3 months. Fassoulaki et al [60] evaluated the use of mexiletine in a pair of clinical trials. In a randomized, placebo-controlled trial, the incidence of CPSP and pain scores did not differ between study arms.…”

Section: Local Anestheticsmentioning

confidence: 99%

“…Utilizing different classes of medication to target different peripheral and CNS mechanisms to reduce acute pain, reducing opioid analgesic requirements postoperatively and improving opioid related side effects has been shown to be successful in clinical trials [60,64]. However, RCTs that examine specific surgery-related multimodal regimens versus placebo and follow patients for preventive analgesic effects (i.e., 3 months or greater following surgery) are limited.…”

Section: Multimodal Analgesiamentioning

confidence: 99%

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Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Clarke

Poon

Weinrib

et al. 2015

Drugs

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Chronic post-surgical pain (CPSP) is a serious complication of major surgery that can impair a patient's quality of life. The development of CPSP is a complex process which involves biologic, psychosocial, and environmental mechanisms that have yet to be fully understood. Currently perioperative pharmacologic interventions aim to suppress and prevent sensitization with the aim of reducing pain and analgesic requirement in acute as well as long-term pain . Despite the detrimental effects of CPSP on patients, the body of literature focused on treatment strategies to reduce CPSP remains limited and continues to be understudied. This article reviews the main pharmacologic candidates for the treatment of CPSP, discusses the future of preventive analgesia, and considers novel strategies to help treat acute postoperative pain and lessen the risk that it becomes chronic. In addition, this article highlights important areas of focus for clinical practice including: multimodal management of CPSP patients, psychological modifiers of the pain experience, and the development of a Transitional Pain Service specifically designed to manage patients at high risk of developing chronic post-surgical pain. Key PointsThe development of chronic post-surgical pain (CPSP) is a complex process which involves biologic, psychosocial, and environmental mechanisms.Ketamine (an NMDA antagonist) appears to be the pharmacologic agent with the most consistent positive preventive analgesic results.The variation in patient response to pharmacologic agents can be explained, in part, by genetic polymorphisms.Understanding the heritability of CPSP will be useful when developing predictive algorithms to determine the preoperative risk for developing CPSP.Psychological treatments delivered before and after surgery have the potential to influence the trajectory of CPSP from the earliest days, in combination with multimodal, preventive analgesia.

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Section: Local Anestheticsmentioning

confidence: 99%

Section: Local Anestheticsmentioning

confidence: 99%

Section: Multimodal Analgesiamentioning

confidence: 99%

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Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Clarke

Poon

Weinrib

et al. 2015

Drugs

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“…Radiation therapy may also induce injury, leading to microvascular insufficiency and fibrotic changes affecting the nerves and perineural tissues (13), with clinical painful manifestations ranging between 25 and 47% (14). Finally, surgery for diagnostic or therapeutic purposes, may lead to chronic pain as well, with incidence reaching high rates (60-90%) in some cases, such as after surgery for breast cancer (15)(16)(17)(18). Postmastectomy pain syndrome may be particularly troublesome and adversely impair the quality of life of female breast cancer survivors.…”

Section: The Pathophysiology Of Cancer Painmentioning

confidence: 99%

“…Studies by Fassoulaki et al have demonstrated that suitable perioperative analgesic regimens, mainly based on multimodal analgesic techniques, can significantly reduce the incidence and severity of chronic post-mastectomy pain in women after breast surgery for cancer (15)(16)(17)(18). These regimens are based on the concomitant perioperative use of gabapentin, sodium channel blockers (administered topically or systemically) and local anesthetics administered topically or in nerve infiltrations.…”

Section: Preventative Treatmentsmentioning

confidence: 99%

Advances in the therapy of cancer pain: from novel experimental models to evidence-based treatments

2007

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

Weinstein

Levene

Cohen

et al. 2018

Cochrane Database of Systematic Reviews

124

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We conclude that there is moderate-quality evidence that regional anaesthesia may reduce the risk of developing PPP after three to 18 months after thoracotomy and three to 12 months after caesarean section. There is low-quality evidence that regional anaesthesia may reduce the risk of developing PPP three to 12 months after breast cancer surgery. There is moderate evidence that intravenous infusion of local anaesthetics may reduce the risk of developing PPP three to six months after breast cancer surgery.Our conclusions are considerably weakened by the small size and number of studies, by performance bias, null bias, attrition and missing data. Larger, high-quality studies, including children, are needed. We caution that except for breast surgery, our evidence synthesis is based on only a few small studies. On a cautionary note, we cannot extend our conclusions to other surgical interventions or regional anaesthesia techniques, for example we cannot conclude that paravertebral block reduces the risk of PPP after thoracotomy. There are seven ongoing studies and 12 studies awaiting classification that may change the conclusions of the current review once they are published and incorporated.

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Regional block and mexiletine: The effect on pain after cancer breast surgery

Cited by 30 publications

References 10 publications

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Advances in the therapy of cancer pain: from novel experimental models to evidence-based treatments

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

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