DOI: http://dx.doi.org/10.18203/2349-2902.isj20192353

Post mastectomy pain control using bupivacaine installation via wound drains

Mahmoud A. Alhussini, Ahmed T. Awad, Akram M. Girgis, Tarek A. El Fayomi, H. M. Agameya

Abstract


Background: This study is a controlled prospective randomized blinded study. Our aim was to evaluate the effect of wound installation with bupivacanie through surgical drains to control postoperative pain and decrease the use of systemic analgesics after mastectomy.

Methods: This study was conducted on 168 female patients candidates for modified radical mastectomy admitted to the Surgical Oncology Unit, Faculty of Medicine, University of Alexandria. Patients were randomly divided into two equal groups. Group A Bupivacaine was installed through axillary and chest wall drains by the end of surgery. While, group B was installed by equal amount of normal saline as placebo. We assessed the visual analogue score (VAS), need and timing for systemic analgesics during the first 24 hours.

Results: The mean values for VAS were always lower in group A. This was reflected on the timing and need for additional analgesia.

Conclusions: We concluded from this study that using bupivacaine instillation through surgical drains is an effective and easy method to control post mastectomy pain and enhance patients' recovery in the first 24 hours postoperative.


Keywords


Breast, Bupivacaine, Mastectomy, Postoperative analgesia, Wound instillation

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References


Flum DR, Horvath K, Koepsell T. Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg. 2003;237(1):129-35.

Fecho K, Miller NR, Merritt SA, Klauber-Demore N, Hultman CS, Blau WS. Acute and persistent postoperative pain after breast surgery. Pain Med. 2009;10(4):708-15.

Arsalani-Zadeh R, ElFadl D, Yassin N, MacFie J. Evidence-based review of enhancing postoperative recovery after breast surgery. Br J Surg. 2011;98(2):181-96.

Doss NW, Ipe J, Crimi T, Rajpal S, Cohen S, Fogler RJ, et al. Continuous thoracic epidural anesthesia with 0.2% ropivacaine versus general anesthesia for perioperative management of modified radical mastectomy. Anesth Analg. 2001;92(6):1552-7.

Chang SH, Mehta V, Langford RM. Acute and chronic pain following breast surgery. Acute Pain. 2009;11(1):1-14.

Oakley N, Dennison AR, Shorthouse AJ. A prospective audit of simple mastectomy under local anaesthesia. Eur J Surg Oncol. 1996;22(2):134-6.

Huang TT, Parks DH, Lewis SR. Outpatient breast surgery under intercostal block anesthesia. Plast Reconstr Surg. 1979;63(3):299-303.

Fassoulaki A. Brachial plexus block for pain relief after modified radical mastectomy. Anesth Analg. 1982;61(12):986-7.

Lynch EP, Welch KJ, Carabuena JM, Eberlein TJ. Thoracic epidural anesthesia improves outcome after breast surgery. Ann Surg. 1995;222(5):663-9.

Coveney E, Weltz CR, Greengrass R, Iglehart JD, Leight GS, Steele SM, et al. Use of paravertebral block anesthesia in the surgical management of breast cancer: experience in 156 cases. Ann Surg. 1998;227(4):496-501.

Boddy AP, Mehta S, Rhodes M. The effect of intraperitoneal local anesthesia in laparoscopic cholecystectomy: a systematic review and meta-analysis. Anesth Analg. 2006;103(3):682-8.

Zohar E, Fredman B, Phillipov A, Jedeikin R, Shapiro A. The analgesic efficacy of patient-controlled bupivacaine wound instillation after total abdominal hysterectomy with bilateral salpingo-oophorectomy. Anesth Analg. 2001;93(2):482-7.

World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-4.

Baudry G, Steghens A, Laplaza D, Koeberle P, Bachour K, Bettinger G, et al. Ropivacaine infiltration during breast cancer surgery: postoperative acute and chronic pain effect. Ann Fr Anesth Reanim. 2008;27(12):979-86.

Campbell I, Cavanagh S, Creighton J, French R, Banerjee S, Kerr E, et al. To infiltrate or not? Acute effects of local anaesthetic in breast surgery. ANZ J Surg. 2015;85(5):353-7.

Vigneau A, Salengro A, Berger J, Rouzier R, Barranger E, Marret E, et al. A double blind randomized trial of wound infiltration with ropivacaine after breast cancer surgery with axillary nodes dissection. BMC Anesthesiol. 2011;11:23.

Talbot H, Hutchinson SP, Edbrooke DL, Wrench I, Kohlhardt SR. Evaluation of a local anaesthesia regimen following mastectomy. Anaesthesia. 2004;59(7):664-7.

Rica MA, Norlia A, Rohaizak M, Naqiyah I. Preemptive ropivacaine local anaesthetic infiltration versus postoperative ropivacaine wound infiltration in mastectomy: postoperative pain and drain outputs. Asian J Surg. 2007;30(1):34-9.

Zielinski J, Jaworski R, Smietanska I, Irga N, Wujtewicz M, Jaskiewicz J. A randomized, double-blind, placebo-controlled trial of preemptive analgesia with bupivacaine in patients undergoing mastectomy for carcinoma of the breast. Med Sci Monit. 2011;17(10):589-97.

Mohamed SA, Abdel-Ghaffar HS. Effect of the addition of clonidine to locally administered bupivacaine on acute and chronic postmastectomy pain. J Clin Anesth. 2013;25(1):20-7.

Johansson A, Kornfalt J, Nordin L, Svensson L, Ingvar C, Lundberg J. Wound infiltration with ropivacaine and fentanyl: effects on postoperative pain and PONV after breast surgery. J Clin Anesth. 2003;15(2):113-8.

Johansson A, Axelson J, Ingvar C, Luttropp HH, Lundberg J. Preoperative ropivacaine infiltration in breast surgery. Acta Anaesthesiol Scand. 2000;44(9):1093-8.

Kissin I. Preemptive analgesia. Anesthesiol: J Am Soc Anesthesiol. 2000;93(4):1138-43.

Ballantyne J. Preemptive analgesia: an unsolved problem. Curr Opin Anaesthesiol. 2001;14(5):499-504.

Marret E, Vigneau A, Salengro A, Noirot A, Bonnet F. Effectiveness of analgesic techniques after breast surgery: a meta-analysis. Ann Fr Anesth Reanim. 2006;25(9):947-54.

Arunakul P, Ruksa A. General anesthesia with thoracic paravertebral block for modified radical mastectomy. J Med Assoc Thai. 2010;93(7):149-53.

Jonnavithula N, Khandelia H, Durga P, Ramachandran G. Role of wound instillation with bupivacaine through surgical drains for postoperative analgesia in modified radical mastectomy. Indian J Anaesth. 2015;59(1):15-20.

Uematsu T, Kasami M. Risk of needle tract seeding of breast cancer: cytological results derived from core wash material. Breast Cancer Res Treat. 2008;110(1):51-5.

Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiol. 2006;105(4):660-4.

Karthikesalingam A, Walsh SR, Markar SR, Sadat U, Tang TY, Malata CM. Continuous wound infusion of local anaesthetic agents following colorectal surgery: systematic review and meta-analysis. World J Gastroenterol. 2008;14(34):5301-5.

Wang LW, Wong SW, Crowe PJ, Khor KE, Jastrzab G, Parasyn AD, et al. Wound infusion with local anaesthesia after laparotomy: a randomized controlled trial. ANZ J Surg. 2010;80(11):794-801.