Muska Khpal1,2, James R C Miller3, Zika Petrovic4, Delilah Hassanally4. 1. Anesthetics and Surgical Department, Medway Maritime Foundation Trust, Gillingham, Kent, UK. m.khpal@nhs.net. 2. Anesthetics Department, University College Hospital, London, UK. m.khpal@nhs.net. 3. UCL Medical School, University College London, London, UK. 4. Anesthetics and Surgical Department, Medway Maritime Foundation Trust, Gillingham, Kent, UK.
Abstract
BACKGROUND: Axillary node dissection has a central role in the surgical management of breast cancer; however, it is associated with a significant risk of lymphoedema and chronic pain. Peri-operative administration of local anesthesia reduces acute and persistent post-surgical pain, but there is currently no consensus on the optimal method of local anesthetic delivery. METHODS:Patients undergoing axillary dissection for breast cancer were randomly assigned to receive a one-off dose of levobupivacaine 0.5% (up to 2 mg/kg) following surgery, either via the surgical drain or by direct skin infiltration. Post-operative pain control at rest and on shoulder abduction was assessed using a numerical rating scale. Total analgesia consumption 48 h after surgery was also recorded. RESULTS:Pain scores were significantly lower when local anesthesia was administered via surgical drain at both 3 and 12 h after surgery; this trend extended to 24 h post-operatively. However, pain scores on shoulder abduction did not differ at the 12 or 24 h time points. No differences were found in the total analgesia consumption or length of hospital stay between treatment groups. DISCUSSION: This study demonstrates that local anesthetic delivery via a surgical drain provides improved pain control compared to direct skin infiltration following axillary node dissection. This is likely to be important for the management of acute pain in the immediate post-operative period; however, further studies may be required to validate this in specific patient subgroups, e.g., breast-conserving surgery versus mastectomy.
RCT Entities:
BACKGROUND: Axillary node dissection has a central role in the surgical management of breast cancer; however, it is associated with a significant risk of lymphoedema and chronic pain. Peri-operative administration of local anesthesia reduces acute and persistent post-surgical pain, but there is currently no consensus on the optimal method of local anesthetic delivery. METHODS:Patients undergoing axillary dissection for breast cancer were randomly assigned to receive a one-off dose of levobupivacaine 0.5% (up to 2 mg/kg) following surgery, either via the surgical drain or by direct skin infiltration. Post-operative pain control at rest and on shoulder abduction was assessed using a numerical rating scale. Total analgesia consumption 48 h after surgery was also recorded. RESULTS:Pain scores were significantly lower when local anesthesia was administered via surgical drain at both 3 and 12 h after surgery; this trend extended to 24 h post-operatively. However, pain scores on shoulder abduction did not differ at the 12 or 24 h time points. No differences were found in the total analgesia consumption or length of hospital stay between treatment groups. DISCUSSION: This study demonstrates that local anesthetic delivery via a surgical drain provides improved pain control compared to direct skin infiltration following axillary node dissection. This is likely to be important for the management of acute pain in the immediate post-operative period; however, further studies may be required to validate this in specific patient subgroups, e.g., breast-conserving surgery versus mastectomy.
Entities:
Keywords:
Anesthesia, local; Breast neoplasms; Lymph node excision; Pain, post-operative
Authors: Uzma Shamim Seth; Sughra Perveen; Tanweer Ahmed; Mohammad Taha Kamal; Jehangir Ali Soomro; Munira Murtaza Khomusi; Maha Kamal Journal: Cureus Date: 2022-04-13
Authors: Giuseppe Paladini; Stefano Di Carlo; Giuseppe Musella; Emiliano Petrucci; Paolo Scimia; Andrea Ambrosoli; Vincenza Cofini; Pierfrancesco Fusco Journal: J Pain Res Date: 2020-01-31 Impact factor: 3.133