Placebo-controlled trial of local anaesthesia for treatment of pain after breast reconstruction

Abstract

Breast reconstruction with submuscular tissue implants is associated with substantial postoperative pain. High pain scores despite large doses of opioids were described in earlier studies, which indicated that opioids alone or together with paracetamol are insufficient. In the present placebo-controlled study we aimed to evaluate the analgesic efficacy of local anaesthesia as a supplement. Forty-three women who had previously been operated on for breast cancer and were listed for unilateral secondary breast reconstruction were assigned at random to one of two groups. The patients received 2.5 mg/ml levobupivacaine (Chirocaine) 15 ml or placebo in a double-blind manner through an indwelling catheter in the operation site every three hours for 45 hours. All patients were given oral paracetamol 1 g x 4 orally and morphine intravenously as patient-controlled analgesia. A visual analogue scale (VAS) was used to assess the intensity of the postoperative pain. Amount of morphine used was recorded. The women in the levobupivacaine group (n=21) reported significantly less pain at rest during the first 15 hours postoperatively (p<0.05). During mobilisation the intensity of pain was lower for the first six hours (p=0.01) and for the interval 18-24 hours (p=0.045) in the same group. Total mean (SD) consumption of opioids in the levobupivacaine and placebo groups was 24.6 mg (22.88) and 33.8 mg (30.82), respectively (p=0.28). After reconstruction, levobupivacaine injected locally every third hour as a supplement to paracetamol orally and morphine given by PCA resulted in improved pain relief at rest and during mobilisation. Morphine consumption was reduced, but this was not significant (p=0.28).

Cost-Effectiveness Analysis of Levobupivacaine 0.5 %, a Local Anesthetic, Infusion in the Surgical Wound After Modified Radical Mastectomy

“…However, this period is not completely fixed in the literature and there is a variety of possibilities. Several studies [6,[18][19][20][21][41][42][43][44][45][46][47][48] have administered these anesthetics from 24 h to 10 days. Pacik et al [5] used the infusion of a local anesthetic in 200 mammoplasties, remarking that 172 patients were administered the infusion for 24 h and 28 patients for 48 h. The study by Rawal et al [47] is very significant in terms of time of administration of the pump.…”

“…A meta-analysis on the different studies examining the effectiveness of the administration of a local anesthetic suggests a potential saving of one day hospital stay [13], thereby saving the costs involved. In the studies on infusion of a local anesthetic in breast surgery, there is great variability in the length of hospital stay, ranging from 3 to 10 days [18][19][20][21][22].…”

Does a continuous local anaesthetic pain treatment after immediate tissue expander reconstruction in breast carcinoma patients more efficiently reduce acute postoperative pain - a prospective randomised study

“…To our knowledge, only three studies have been published on the use of local anaesthetics for the treatment of acute postoperative pain after breast reconstruction [8-10]. Use of local anaesthetics administered into the surgical wound has been shown to be an effective treatment for postoperative pain control and decreased opioid consumption.…”

“…However, only a small number of patients were included in these studies. Only one of the studies was prospective and randomized [8] but it was performed on patients with delayed breast reconstruction after mastectomy. We failed to find any prospective randomized trial on the use of local anaesthetics for the treatment of postoperative pain after primary breast reconstruction with a tissue expander.…”

Multimodal Analgesia for Postoperative Pain Management

“…Particularly, local anesthetic toxicity, wound infection and healing do not appear to be major problems (Buvanendran&Kroin, 2009). Although the benefit of local wound infiltration has been documented (Barr-Dayan et al, 2004;Legeby et al, 2009;Park et al, 2002), controversy exists as to the appropriate timing of administering local anesthesia for surgery. A single injection of local anesthetics into the wound is unlikely to have long-lasting effects.…”