Justin Oh1, M Gabrielle Pagé2, Toni Zhong3, Stuart McCluskey1,4, Coimbatore Srinivas1,4, Anne C O'Neill3, James Kahn1, Joel Katz1,4,5, Stefan O P Hofer3, Hance Clarke1,4. 1. Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada. 2. Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada. 3. Division of Plastic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. 4. Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada. 5. Department of Psychology, York University, Toronto, Ontario, Canada.
Abstract
BACKGROUND:Chronic postsurgical pain (CPSP) is a debilitating and costly condition. Risk factors for CPSP after autologous breast reconstruction have not been clearly established. Previously, we demonstrated that transversus abdominis plane (TAP) catheters delivering intermittent local anesthetic reduced postoperative morphine consumption. This prospective follow-up study aimed to (1) compare the incidence of CPSP after autologous breast reconstruction between patients who received postoperative intermittent TAP catheters withbupivacaine or saline boluses and (2) assess the factors that contribute to the development and maintenance of CPSP in this study cohort. METHODS:Ninety-three patients who underwent deep inferior epigastric artery perforator or muscle-sparing transverse rectus abdominis breast reconstruction were randomized to receive TAP catheters with bupivacaine or saline postoperatively. Subsequently, patients were followed for a year to assess persistent pain, pain severity, quality of life scores, and functional disability at 6 and 12 months after surgery. RESULTS: Twenty-four percent and 23% of patients reported CPSP at 6 and 12 months, respectively. There were no significant differences between groups (bupivacaine vs. placebo) on pain-related variables, including incidence of CPSP. Patients who reported greater variability in pain scores at rest over the first 48 hours postoperatively were more likely to have CPSP 6 months, but not 12 months, later. CONCLUSIONS: Acute postoperative pain variability may contribute to the development of CPSP up to 6 months after autologous breast reconstruction surgery. Neither postoperative use of bupivacaine vs. saline in the TAP catheters nor acute pain severity influenced the 6- or 12-month incidence of CPSP.
RCT Entities:
BACKGROUND: Chronic postsurgical pain (CPSP) is a debilitating and costly condition. Risk factors for CPSP after autologous breast reconstruction have not been clearly established. Previously, we demonstrated that transversus abdominis plane (TAP) catheters delivering intermittent local anesthetic reduced postoperative morphine consumption. This prospective follow-up study aimed to (1) compare the incidence of CPSP after autologous breast reconstruction between patients who received postoperative intermittent TAP catheters with bupivacaine or saline boluses and (2) assess the factors that contribute to the development and maintenance of CPSP in this study cohort. METHODS: Ninety-three patients who underwent deep inferior epigastric artery perforator or muscle-sparing transverse rectus abdominis breast reconstruction were randomized to receive TAP catheters with bupivacaine or saline postoperatively. Subsequently, patients were followed for a year to assess persistent pain, pain severity, quality of life scores, and functional disability at 6 and 12 months after surgery. RESULTS: Twenty-four percent and 23% of patients reported CPSP at 6 and 12 months, respectively. There were no significant differences between groups (bupivacaine vs. placebo) on pain-related variables, including incidence of CPSP. Patients who reported greater variability in pain scores at rest over the first 48 hours postoperatively were more likely to have CPSP 6 months, but not 12 months, later. CONCLUSIONS: Acute postoperative pain variability may contribute to the development of CPSP up to 6 months after autologous breast reconstruction surgery. Neither postoperative use of bupivacaine vs. saline in the TAP catheters nor acute pain severity influenced the 6- or 12-month incidence of CPSP.
Authors: Jinshil Hyun; Jiyue Qin; Cuiling Wang; Mindy J Katz; Jelena M Pavlovic; Carol A Derby; Richard B Lipton Journal: J Pain Date: 2021-11-13 Impact factor: 5.820
Authors: Erica J Weinstein; Jacob L Levene; Marc S Cohen; Doerthe A Andreae; Jerry Y Chao; Matthew Johnson; Charles B Hall; Michael H Andreae Journal: Cochrane Database Syst Rev Date: 2018-06-20
Authors: Ivan Urits; Christopher Lavin; Megha Patel; Nishita Maganty; Xander Jacobson; Anh L Ngo; Richard D Urman; Alan D Kaye; Omar Viswanath Journal: Pain Ther Date: 2020-01-28
Authors: Erica J Weinstein; Jacob L Levene; Marc S Cohen; Doerthe A Andreae; Jerry Y Chao; Matthew Johnson; Charles B Hall; Michael H Andreae Journal: Cochrane Database Syst Rev Date: 2018-04-25