Postoperative analgesia by infusion of local anesthetic into the surgical wound after modified radical mastectomy: a randomized clinical trial.

Abstract

BACKGROUND:

There is no consensus on the efficacy of postoperative infusion of local anesthetics after radical mastectomy.

METHODS:

A randomized, double-blind, placebo-controlled, parallel-groups clinical trial was conducted in a tertiary hospital. Eighty consecutive women with operable breast cancer with indications for modified radical mastectomy without breast reconstruction were assigned randomly to receive infusion of levobupivacaine (0.5%) or saline at 2 ml/hour for 48 hours through a wound catheter. Seventy-three women finished the study (intervention group, n = 34; control group, n = 39). During surgery, all patients received 0.25% levobupivacaine (30 ml).

RESULTS:

The levobupivacaine group reported less pain (p < 0.001) than controls in the postanesthesia care unit (1.6 ± 1.3 versus 6.7 ± 1.8) and on the ward at 24 (0.8 ± 0.9 versus 4.2 ± 1.9) and 48 (0.4 ± 0.7 versus 3.3 ± 2.3) hours. In the postanesthesia care unit, the levobupivacaine group consumed less metamizole (0.4 ± 0.5 versus 0.8 ± 0.4; p < 0.001) and dexketoprofen (0.1 ± 0.3 versus 0.7 ± 0.4; p < 0.001), with differences in paracetamol use being insignificant (0.8 ± 0.4 versus 0.9 ± 0.3; p = 0.140). On the ward, the levobupivacaine group used significantly less paracetamol (0.5 ± 0.7 versus 2.0 ± 2.0; p < 0.001) and metamizole (0.2 ± 0.4 versus 1.2 ± 1.4; p < 0.001), but differences in dexketoprofen were not significant (0.03 ± 0.2 versus 0.2 ± 0.6; p = 0.074). In the postanesthesia care unit, the levobupivacaine and control groups consumed 0 ± 0 and 0.7 ± 1.2 doses of opioids (p = 0.001), respectively. The authors observed no differences in nausea and vomiting at any stage in the postanesthesia care unit (0.2 ± 0.4 versus 0.4 ± 0.5; p = 0.081) or on the ward (0.3 ± 0.5 versus 0.4 ± 0.5; p = 0.563). All participants reported high levels of satisfaction.

CONCLUSION:

Continuous infusion of local anesthetic reduces pain and analgesic consumption, with high satisfaction, but does not affect rates of nausea and vomiting.

• Authors: Lourdes Ferreira Laso, Amanda Lopez-Picado, Laura Lamata, Mar Ceballos Garcia, Carolina Ibañez López, Lorena Pipaon Ruilope, Felix Lamata Hernandez, Fernando Antoñanzas Villar, Cesar Valero Martinez, Felipe Aizpuru, Roberto Hernanz Chaves
• Journal: Plastic and reconstructive surgery (Plast Reconstr Surg) Vol. 134 Issue 6 Pg. 862e-870e (Dec 2014) ISSN: 1529-4242 [Electronic] United States
• PMID: 25415108 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Anesthetics, Local
• Levobupivacaine
• Bupivacaine

Topics

• Adult
• Aged
• Anesthetics, Local (administration & dosage, therapeutic use)
• Bupivacaine (administration & dosage, analogs & derivatives, therapeutic use)
• Double-Blind Method
• Female
• Humans
• Infusions, Intralesional
• Levobupivacaine
• Mastectomy, Modified Radical
• Middle Aged
• Pain Measurement
• Pain, Postoperative (drug therapy)
• Patient Satisfaction (statistics & numerical data)
• Treatment Outcome