Persistent postmastectomy pain and pain-related physical and emotional functioning with and without a continuous paravertebral nerve block: a prospective 1-year follow-up assessment of a randomized, triple-masked, placebo-controlled study.

Abstract

BACKGROUND:

In a previous randomized, triple-masked, placebo-controlled study, the authors demonstrated that extending a single-injection paravertebral nerve block with a multiple-day perineural local anesthetic infusion improves analgesia and decreases pain-related dysfunction during the 3-day infusion but not subsequent to catheter removal within 1 month after mastectomy. This report describes a prospective follow-up study of the previously published trial to investigate the possibility that extending a single-injection paravertebral block with a multiple-day infusion may decrease persistent postsurgical pain as well as pain-induced emotional and functional dysfunction 1 year after mastectomy.

METHODS:

Subjects undergoing uni- or bilateral mastectomy received unilateral (n = 24) or bilateral (n = 36) single-injection thoracic paravertebral block(s) with ropivacaine and perineural catheter(s). The subjects were randomized to receive either ropivacaine 0.4 % (n = 30) or normal saline (n = 30) via their catheters until the catheters were removed on postoperative day 3. Chronic pain and pain-related physical and emotional dysfunction were measured using the Brief Pain Inventory (BPI).

RESULTS:

No statistically significant difference between treatments 3 months after surgery was observed with the BPI. In contrast, after 12 months, only 4 subjects (13 %) who had received a perineural ropivacaine infusion reported pain-induced dysfunction compared with 14 (47 %) who had received saline infusion (P = 0.011). At 12 months, the mean BPI was 1.6 ± 4.6 for the subjects who received ropivacaine versus 5.9 ± 11.3 for the subjects who received saline (P = 0.007).

CONCLUSIONS:

Adding a multiple-day, continuous ropivacaine infusion to a single-injection ropivacaine paravertebral nerve block may result in a lower incidence of pain as well as pain-related physical and emotional dysfunction 1 year after mastectomy.

• Authors: Brian M Ilfeld, Sarah J Madison, Preetham J Suresh, NavParkash S Sandhu, Nicholas J Kormylo, Nisha Malhotra, Vanessa J Loland, Mark S Wallace, Edward J Mascha, Zekun Xu, Cindy H Wen, Anya C Morgan, Anne M Wallace
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 22 Issue 6 Pg. 2017-25 ( 2015) ISSN: 1534-4681 [Electronic] United States
• PMID: 25413267 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Amides
• Anesthetics, Local
• Ropivacaine

Topics

• Adult
• Amides (administration & dosage)
• Anesthetics, Local (administration & dosage)
• Breast Neoplasms (pathology, psychology, surgery)
• Female
• Follow-Up Studies
• Humans
• Infusions, Parenteral
• Mastectomy (adverse effects)
• Middle Aged
• Nerve Block
• Pain Measurement
• Pain, Postoperative (drug therapy, etiology)
• Prognosis
• Prospective Studies
• Ropivacaine
• Stress, Psychological (etiology)