Does the perioperative analgesic/anesthetic regimen influence the prevalence of long-term chronic pain after mastectomy?

Steyaert, Arnaud; Forget, Patrice; Dubois, Virginie; Lavand’homme, Patricia; Kock, Marc De

doi:10.1016/j.jclinane.2015.07.010

Cited by 36 publications

(21 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast with previous studies, we have not observed an association between CPBS and patient age (Gartner et al 2009;Vilholm et al 2008), previous breast surgery (Vilholm et al 2008), reconstructive surgery (Roth 2018) or implant-device placement (both above or below the pectoralis major muscle) (Wallace et al 1996). On the other hand, our study con rms that there is little evidence to suggest CPBS might be in uenced by type of anaesthesia (Cho et al 2013;Steyaert et al 2016;Veevaete and Lavand'homme 2014). However, it should be recognised that anaesthesiologic factors considered in this study are biased towards totally intravenous anaesthesia, thus calling for caution when interpreting the results.…”

Section: Discussioncontrasting

confidence: 99%

Chronic pain after breast surgery: incidence, associated factors and impact on quality of life, an observational prospective study

Villa

Mandarano

Calabrisotto

et al. 2020

Preprint

View full text Add to dashboard Cite

Background. Chronic pain after breast surgery (CPBS) has a disabling impact on postoperative health status. Mainly because of the lack of a clear definition, inconsistency does exist in the literature concerning both the actual incidence and the risk factors associated to CPBS. The aim of this prospective, observational study is to describe the incidence of and risk factors for CPBS, according to the definition provided by the IASP taskforce. The impact of CPBS on patients’ function and quality of life is also described. Methods. Adult female patients scheduled for oncological or reconstructive breast surgery at the Breast Unit of Careggi Hospital (Florence, Italy) were prospectively observed. Postoperative pain was evaluated at 2 months (“pain becoming chronic”) and at 3 months (CPBS) after surgery. Preoperative, intraoperative, and postoperative factors were compared in CPBS and No-CPBS groups through multivariate logistic regression analysis. Results. Among the 307 patients considered in this study, the incidence of “pain becoming chronic” was 25.4% [95%CI 20.6%-30.7%], while that of CPBS was 28% [95%CI 23.1%-33.4%]. The presence of pain at 2 months concords with the presence of CPBS at 3 months (Cohen k coefficient 0.63, IC95% 0.54-0.73). Results from the logistic regression analysis suggest that axillary surgery (OR [95%CI], 2.99 [1.13-7.87], p=0.03), preoperative use of pain medications (OR [95%CI], 2.04 [1.20-3.46], p=0.01), and higher dynamic NRS values at 6 hours postoperatively (OR [95%CI], 1.28 [1.05-1.55], p=0.01) were all independent predictors for CPBS. Conclusions. Chronic pain after breast surgery is a frequent complication. The presence of early pain at 2 months after surgery concords with the occurrence of CPBS. The possibility to early detect persistent pain, particularly in those patients at high risk for CPBS, might help physicians to more effectively prevent pain chronicization. In our cohort, long-term use of analgesics for preexisting chronic pain, axillary surgery, and higher dynamic NRS values at 6 hours postoperatively were all factors associated with increased risk of developing CPBS. Trial registration: clinicalTrials.gov registration NCT04309929

show abstract

Section: Discussioncontrasting

confidence: 99%

Chronic pain after breast surgery: incidence, associated factors and impact on quality of life, an observational prospective study

Villa

Mandarano

Calabrisotto

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Previous studies have demonstrated that PECS or SAM block reduced opioid consumption in breast cancer surgery 15 , 17 , 30 , 31 . Intraoperative high doses of opioids are associated with long-term chronic pain after mastectomy 32 .…”

Section: Discussionmentioning

confidence: 99%

Benefits in radical mastectomy protocol: a randomized trial evaluating the use of regional anesthesia

Matsumoto

Flores

Kimachi

et al. 2018

Sci Rep

View full text Add to dashboard Cite

Surgery is the first-line treatment for early, localized, or operable breast cancer. Regional anesthesia during mastectomy may offer the prevention of postoperative pain. One potential protocol is the combination of serratus anterior plane block (SAM block) with pectoral nerve block I (PECS I), but the results and potential benefits are limited. Our study compared general anesthesia with or without SAM block + PECS I during radical mastectomy with axillary node dissection and breast reconstruction using evaluations of pain, opioid consumption, side effects and serum levels of interleukin (IL)-1beta, IL-6 and IL-10. This is a prospective, randomized controlled trial. Fifty patients were randomized to general anesthesia only or general anesthesia associated with SAM block + PECS I (25 per group). The association of SAM block + PECS I with general anesthesia reduced intraoperative fentanyl consumption, morphine use and visual analog pain scale scores in the post-anesthetic care unit (PACU) and at 24 h after surgery. In addition, the anesthetic protocol decreased side effects and sedation 24 h after surgery compared to patients who underwent general anesthesia only. IL-6 levels increased after the surgery compared to baseline levels in both groups, and no differences in IL-10 and IL-1 beta levels were observed. Our protocol improved the outcomes of mastectomy, which highlight the importance of improving mastectomy protocols and focusing on the benefits of regional anesthesia.

show abstract

“…Although intravenous lidocaine reduced the INTRODUCTION It is estimated that persistent postsurgical pain affects 15% to 60% of patients undergoing surgical procedures, and its incidence varies with the surgical procedure. [1][2][3] Multimodal analgesia approaches have been demonstrated to reduce opioid consumption, improve pain management, and reduce postoperative opioidinduced complications. 4,5 The development of chronic pain (> 3 months) has been linked to the intensity of perioperative pain; therefore, it is conceivable that preemptive multimodal analgesic strategies may also reduce the development of chronic postsurgical pain.…”

Section: Methodsmentioning

confidence: 99%

“…It is estimated that persistent postsurgical pain affects 15% to 60% of patients undergoing surgical procedures, and its incidence varies with the surgical procedure . Multimodal analgesia approaches have been demonstrated to reduce opioid consumption, improve pain management, and reduce postoperative opioid‐induced complications .…”

Section: Introductionmentioning

confidence: 99%

The Effect of Intraoperative Systemic Lidocaine on Postoperative Persistent Pain Using Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials Criteria Assessment Following Breast Cancer Surgery: A Randomized, Double‐Blind, Placebo‐Controlled Trial

et al. 2017

View full text Add to dashboard Cite

Perioperative infusion of lidocaine has been reported to decrease the incidence of postsurgical pain at 3 and 6 months following mastectomy using dichotomous (yes/no) scoring. Although intravenous lidocaine reduced the reported incidence of pain at rest at 6 months, pain with activity, pain qualities, and the physical or emotional impact of the pain were unaffected. Future studies evaluating postsurgical persistent pain should adhere to the IMMPACT recommendations in order to more accurately describe the effect of an intervention on persistent pain.

show abstract

Does the perioperative analgesic/anesthetic regimen influence the prevalence of long-term chronic pain after mastectomy?

Cited by 36 publications

References 21 publications

Chronic pain after breast surgery: incidence, associated factors and impact on quality of life, an observational prospective study

Chronic pain after breast surgery: incidence, associated factors and impact on quality of life, an observational prospective study

Benefits in radical mastectomy protocol: a randomized trial evaluating the use of regional anesthesia

The Effect of Intraoperative Systemic Lidocaine on Postoperative Persistent Pain Using Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials Criteria Assessment Following Breast Cancer Surgery: A Randomized, Double‐Blind, Placebo‐Controlled Trial

Contact Info

Product

Resources

About