To infiltrate or not? Acute effects of local anaesthetic in breast surgery

Campbell, Ian; Cavanagh, Shelley; Creighton, J. E.; French, Rowan; Banerjee, S.; Kerr, E. Beth; Shirley, Rachel

doi:10.1111/ans.12541

Cited by 24 publications

(22 citation statements)

References 14 publications

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“…The surgical procedures performed in the reviewed trials included lumpectomy or mastectomy in 14 of 19 trials [ 10 – 23 ], with additional Sentinel Lymph Node Biopsy (SLNB) or Axillary Lymph Node Dissection (ALND) [ 10 , 12 , 14 – 18 , 20 , 21 , 23 ]. Three trials included patients undergoing breast augmentation [ 24 – 26 ], and two trials also included patients undergoing breast reduction [ 27 , 28 ].…”

Section: Resultsmentioning

confidence: 99%

“…Patients underwent mastectomy, while lumpectomy was performed in 4 studies ( Campbell et al , [ 10 ] ; Cros et al , [ 12 ] ; Gürkan et al , [ 14 ] ; Versyck et al , [ 20 ]). Lanier et al [ 16 ] and Wang et al [ 21 ] reported immediate tissue expander or implant based breast reconstruction.…”

Section: Resultsmentioning

confidence: 99%

“…Lanier et al [ 16 ] and Wang et al [ 21 ] reported immediate tissue expander or implant based breast reconstruction. Surgical treatment for breast cancer was associated with a sentinel lymph node biopsy (SLNB) or a axillary lymph node dissection (ALND) in 10 papers ( Campbell et al , [ 10 ] ; Cros et al , [ 12 ] ; Gürkan et al , [ 14 ] ; Ilfeld et al , [ 15 ] ; Lanier et al , [ 16 ] ; Mohamed et al , [ 17 ] ; Neethu et al , 2018; Versyck et al [ 20 ] ;Wang et al , 2018; Yao et al , 2019 ).…”

Section: Resultsmentioning

confidence: 99%

“…Local infiltration was reported in 3 studies. In Campbell et al 2014 [ 10 ] , patients received 20 mL of bupivacaine 0.25% with or without adrenaline to be infiltrated into the breast wound and a further 20 mL of bupivacianee 0.25% with adrenaline to be infiltrated into the axilla wound when applicable. In Mohamed et al 2013, 5 ml of bupivacaine 0.5% with or without clonidine were diluted with saline 0.9% to 15 mL volume and irrigated into the surgical field before skin closure.…”

Section: Resultsmentioning

confidence: 99%

“…For the postoperative pain management, four studies ( Couceiro et al , [ 11 ] ; Cros et al , [ 12 ] ; Ferreira Laso et al , 2014; Ilfeld et al , 2014 ) provided infiltration of the chest wall ipsilateral to the mastectomy with local anesthetic; acetaminophen and other NSAIDs were systematically administered. Two studies did not report the anesthesia protocol ( Campbell et al , 2014 [ 10 ] ; Lanier et al , 2018 ).…”

Section: Resultsmentioning

confidence: 99%

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What is the role of locoregional anesthesia in breast surgery? A systematic literature review focused on pain intensity, opioid consumption, adverse events, and patient satisfaction

et al. 2020

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Background Breast surgery in the United States is common. Pain affects up to 50% of women undergoing breast surgery and can interfere with postoperative outcomes. General anesthesia is the conventional, most frequently used anaesthetic technique. Various locoregional anesthetic techniques are also used for breast surgeries. A systematic review of the use of locoregional anesthesia for postoperative pain in breast surgery is needed to clarify its role in pain management. Objectives To systematically review literature to establish the efficacy and the safety of locoregional anesthesia used in the treatment of pain after breast surgery. Methods Embase, MEDLINE, Google Scholar and Cochrane Central Trials Register were systematically searched in Mars 2020 for studies examining locoregional anesthesia for management of pain in adults after breast surgery. The methodological quality of the studies and their results were appraised using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and specific measurement properties criteria, respectively. Results Nineteen studies evaluating locoregional anesthesia were included: 1058 patients underwent lumpectomy/mastectomy, 142 breast augmentation and 79 breast reduction. Locoregional anesthesia provides effective anesthesia and analgesia in the perioperative setting, however no statistically significant difference emerged if compared to other techniques. For mastectomy only, the use of locoregional techniques reduces pain in the first hour after the end of the surgery if compared to other procedures (p = 0.02). Other potentially beneficial effects of locoregional anesthesia include decreased need for opioids, decreased postoperative nausea and vomiting, fewer complications and increased patient satisfaction. All this improves postoperative recovery and shortens hospitalization stay. In none of these cases, locoregional anesthesia was statistically superior to other techniques. Conclusion The results of our review showed no differences between locoregional anesthesia and other techniques in the management of breast surgery. Locoregional techniques are superior in reducing pain in the first hour after mastectomy.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

What is the role of locoregional anesthesia in breast surgery? A systematic literature review focused on pain intensity, opioid consumption, adverse events, and patient satisfaction

et al. 2020

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Preventing pain after breast surgery: A systematic review with meta‐analyses and trial‐sequential analyses

Lepot

Elia

Tramèr

et al. 2020

European Journal of Pain

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Background and objective: The aim of this systematic review was to indirectly compare the efficacy of any intervention, administered perioperatively, on acute and persistent pain after breast surgery. Databases and data treatment: We searched for randomized trials comparing analgesic interventions with placebo or no treatment in patients undergoing breast surgery under general anaesthesia. Primary outcome was intensity of acute pain (up to 6 hr postoperatively). Secondary outcomes were cumulative 24-hr morphine consumption, incidence of postoperative nausea and vomiting (PONV), and chronic pain. We used an original three-step approach. First, meta-analyses were performed when data from at least three trials could be combined; secondly, trial sequential analyses were used to separate conclusive from unclear evidence. And thirdly, the quality of evidence was rated with GRADE. Results: Seventy-three trials (5,512 patients) tested loco-regional blocks (paravertebral, pectoralis), local anaesthetic infiltrations, oral gabapentinoids or intravenous administration of glucocorticoids, lidocaine, N-methyl-D-aspartate antagonists or alpha2 agonists. With paravertebral blocks, pectoralis blocks and glucocorticoids, there was conclusive evidence of a clinically relevant reduction in acute pain (visual analogue scale > 1.0 cm). With pectoralis blocks, and gabapentinoids, there was conclusive evidence of a reduction in the cumulative 24-hr morphine consumption (> 30%). With paravertebral blocks and glucocorticoids, there was conclusive evidence of a relative reduction in the incidence of PONV of 70%. For chronic pain, insufficient data were available. Conclusions: Mainly with loco-regional blocks, there is conclusive evidence of a reduction in acute pain intensity, morphine consumption and PONV incidence after breast surgery. For rational decision making, data on chronic pain are needed. Significance: This quantitative systematic review compares eight interventions, published across 73 trials, to prevent pain after breast surgery, and grades their degree of efficacy. The most efficient interventions are paravertebral blocks, pectoralis blocks and glucocorticoids, with moderate to low evidence for the blocks. Intravenous lidocaine and alpha2 agonists are efficacious to a lesser extent, but with a higher level of evidence. Data for chronic pain are lacking.

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The use of a single local analgesics infusion in operation cavity following mastectomy and its effect on postoperative pain—a retrospective cohort study

Sollie

Bille

2016

Eur J Plast Surg

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Introduction:Pain following mastectomy often require use of opioids, drugs associated with a significant number of side effects. This study investigated the effect of a single perioperative infusion of bupivacaine in the mastectomy cavity on the postoperative outcomes; use of opioids, pain score, and nausea.Methods: This retrospective cohort included 244 women undergoing mastectomies at Odense University Hospital, DK. Thirty five patients received bupivacaine in the mastectomy cavity and were compared to 209 controls who had no local analgesic. Results:A reduction in the postoperative use of 6.1 "Oral Morphine Equivalents" (OMEQ's) was observed in the infusion group in the first 24 hours after mastectomy compared to a control group not recieving infusion. This corresponds to a reduction of 6.1 mg of orally administered morphine, equivalent to a 52% reduction. This was, however, not statistically significant (p=0.1208). No statistically significant differences between the two groups were found in VAS-scores for pain and nausea or in the use of other non-opioid analgesics.Discussion: A single perioperative infusion of bupivacaine may have a morphine sparing effect in the first 24 hours after mastectomy. Our results were however not statistically significant when tested on these low pain surgical procedures. Infusion of analgesics in surgical cavities is simple, fast and low cost. It might prevent the often seen vicious cycle of nausea and impaired coping with post surgical pain when patients are introduced to opioids.

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To infiltrate or not? Acute effects of local anaesthetic in breast surgery

Abstract: LA infiltration during breast surgery has a marked opioid sparing effect, which has significant patient benefits as well as reducing nursing workload and drug costs.

Cited by 24 publications

References 14 publications

What is the role of locoregional anesthesia in breast surgery? A systematic literature review focused on pain intensity, opioid consumption, adverse events, and patient satisfaction

What is the role of locoregional anesthesia in breast surgery? A systematic literature review focused on pain intensity, opioid consumption, adverse events, and patient satisfaction

Preventing pain after breast surgery: A systematic review with meta‐analyses and trial‐sequential analyses

The use of a single local analgesics infusion in operation cavity following mastectomy and its effect on postoperative pain—a retrospective cohort study

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