A Double-blind Randomized Trial of Wound and Intercostal Space Infiltration with Ropivacaine during Breast Cancer Surgery

Abstract

This multicenter, prospective study shows that ropivacaine wound infiltration after breast cancer surgery decreased immediate postoperative pain but did not decrease chronic pain at 3, 6, and 12 months postoperatively.

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

“…Five of the nine studies examined local anesthetics in several surgical populations [12][13][14][15][16], one study compared a tumor necrosis factor-alpha (TNF-a) inhibitor (i.e., enteracept) for inguinal hernia compared to placebo [17], another study compared pregabalin versus placebo in a cardiac surgery model [18], and another study examined minocycline (a broad-spectrum cycline antibiotic which has been shown to block microglial activation) compared to placebo following lumbar discectomy [19]. These eight trials were negative and did not demonstrate a preventive analgesic effect [12][13][14][15][16][17][18][19]. Only one of the nine studies identified in our updated literature search found a preventive effect on the incidence of CPSP [20].…”

“…Similarly, in their second trial comparing mexiletine to gabapentin and placebo, no significant difference was found between trial groups [64]. Within the past year, an additional five studies have been published evaluating the use of local anesthetics for CPSP [12][13][14][15][16]. No significant difference in incidence or pain score was found for any of the agents 2 months or more following the surgery.…”

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

“…Relatedly, nonsteroidal antiinflammatory agents, gabapentin, and local anesthetic wound infiltration/infusion were not used per the surgeon's preferred standard analgesic regimen, the addition of which may have decreased the differences found between the two treatment groups. [42][43][44] In addition, although the overwhelming number of investigations, including those of the current study, involving breast surgery and paravertebral infusion included the third thoracic level for catheter insertion, [45][46][47][48][49][50][51][52] the optimal level for mastectomy analgesia remains unknown. We did not measure blood levels of nociceptive processing or stress response markers that could have helped elucidate any association of perioperative analgesia with persistent postoperative pain and cancer recurrence.…”

Treatment Approaches for Breast Cancer in Netherland Cancer Institute

“…Rekonstrük-siyon yapılacak hastalarda ise subkutan veya pektoral blok uygulamasının yeterli olmayacağı, paravertebral blok uygulamasının tercih edilmesi gerektiği belirtiliyor. Lokal anestezi uygulamaları ile ameliyat sonrasında opioid ihtiyacının azaldığı bildiriliyor (38).…”