Multimodal Analgesia with Gabapentin and Local Anesthetics Prevents Acute and Chronic Pain After Breast Surgery for Cancer

Abstract

We evaluated the effect of multimodal analgesia on acute and chronic pain after breast surgery for cancer. Fifty patients scheduled for breast cancer surgery were blindly randomized to receive gabapentin, eutectic mixture of local anesthetics cream, and ropivacaine in the wound or three placebos. Pain (visual analog scale) and analgesics were recorded in the postanesthesia care unit (PACU) 3, 6, and 9 h and 8 days after surgery. Three and 6 mo later, patients were assessed for chronic pain. The treatment group consumed less paracetamol in the PACU (469 versus 991 mg; P < 0.002) and less Lonalgal (1.0 versus 4.4 tablets; P = 0.003) than the controls, exhibited lower visual analog scale scores at rest in the PACU (P = 0.001) and on postoperative Days 1, 3, and 5 (P = 0.040, P = 0.015, and P = 0.045, respectively), and after movement in the PACU (P = 0.001) and on postoperative Days 2, 4, and 8 (P = 0.028, P = 0.007, and P = 0.032, respectively). Three and 6 mo after surgery, 18 of 22 (82%) and 12 of 21 (57%) of the controls reported chronic pain versus 10 of 22 (45%) and 6 of 20 (30%) in the treatment group (P = 0.028 and P = 0.424, respectively); 5 of 22 and 4 of 21 of the controls required analgesics versus 0 of 22 and 0 of 20 of those treated (P = 0.048 and P = 0.107, respectively). Multimodal analgesia reduced acute and chronic pain after breast surgery for cancer.

Strategies Aimed at Preventing Chronic Post-surgical Pain: Comprehensive Perioperative Pain Management after Total Joint Replacement Surgery

“…141,142 Since one of the primary goals of TKA is to improve physical function, this provides an ideal model to study the effects of gabapentin on functional outcomes. While many trials have demonstrated reductions in movement-induced post-surgical pain, 113,116,118,121,127,130,132 whether this reduction translates into accelerated recovery and/or improved functional outcomes remains unknown. Future trials must evaluate the effects of gabapentin and pregabalin on recovery following TJA within the context of multi-modal analgesia.…”

Postsurgical Pain Syndromes

“…Fassoulaki and colleagues published two randomized controlled studies of perioperative gabapentin [42,43]. In the first [42], women received gabapentin 1200 mg per day (400 mg three times a day), starting the evening before surgery, or mexiletine 600 mg per day (200 mg three times per day) or placebo three times per day.…”

“…There were no significant differences in pain prevalence or intensity, or in analgesic requirement at 3 months follow-up, although the character of the pain in the control group tended to be burning rather than throbbing, aching or stabbing. In the second study [43], women undergoing breast cancer surgery received a combination of gabapentin 1600 mg per day (400 mg four times a day) for 10 days starting the evening before surgery, plus EMLA cream (20 g) for 3 days starting the day of surgery, plus intraoperative irrigation of the brachial plexus with 10 ml of 0.75% ropivacaine. The control group underwent placebo administration of each of the interventions.…”

Traitements pharmacologiques actuels, recommandations et perspectives

“…Certaines molécules ont montré leur efficacité dans la prévention de la douleur chronique postopératoire. Il s'agit essentiellement des antiépileptiques gabapentinoïdes (gabapentine [5,10,[11][12][13]24], prégabaline [7]), des antagonistes des récepteurs N-méthyl-D-Aspartate (NMDA)…”