Reduction or elimination of postoperative pain medication after mastectomy through use of a temporarily placed local anaesthetic pump vs. control group

Morrison, John E.; Jacobs, Volker R.

doi:10.1055/s-2003-40364

Cited by 25 publications

(2 citation statements)

References 13 publications

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“…However, the technique tested involved infiltration via wound drains which deposited local anaesthetic in a more superficial tissue plane than the subpectoral plane and did not use a continuous infusion. Non-randomised, non-blinded, retrospective and observational studies of local anaesthetic infusion24–26 suggest more favourable results. Baroody et al 25 demonstrated a fivefold reduction in analgesic requirement following local anaesthetic infusion after reconstructive breast surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Baroody et al 25 demonstrated a fivefold reduction in analgesic requirement following local anaesthetic infusion after reconstructive breast surgery. Morrison et al 24 compared postoperative opioid use in mastectomy patients receiving local anaesthetic infusion or no infusion and found a significant reduction in opiate use and hospital length of stay in the local anaesthetic arm. However, this was an unblinded retrospective analysis and made no attempt to investigate chronic pain or arm mobility.…”

Section: Introductionmentioning

confidence: 99%

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Study protocol for a double blind, randomised, placebo-controlled trial of continuous subpectoral local anaesthetic infusion for pain and shoulder function following mastectomy: SUB-pectoral Local anaesthetic Infusion following MastEctomy (SUBLIME) study

et al. 2014

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IntroductionOver 16 000 mastectomies are performed in England and Wales annually. Acute postoperative pain and nausea are common. The most frequently occurring long-term complications are chronic pain (up to 50%) and reduced shoulder function (reported at 35%). Regional techniques that improve acute postoperative pain relief may reduce the incidence of these complications. This study assesses the effectiveness of a 24-hour continuous local anaesthetic in the subpectoral plane in improving postoperative pain and quality of life in patients undergoing mastectomy.Methods and analysisThis is a randomised, double blind, placebo-controlled, two-centre, parallel group trial in women undergoing mastectomy with or without axillary involvement. One hundred and sixty participants will be randomised in a 1:1 ratio to receive either 0.25% levobupivacaine or 0.9% saline by subpectoral infusion postoperatively for 24 h. All participants will be provided with an intravenous morphine patient-controlled analgesia (PCA) system. Participants will be followed-up for 24 h in hospital and at approximately 14 days and 6 months postoperatively. Joint primary outcome measures are total morphine consumption and total pain score (captured via patient-recorded visual analogue scale (VAS) 4 hourly) during the first 24 h postoperatively. Primary statistical analysis of total pain is based on the area under the curve of pain versus time graph. Secondary outcomes include PCA attempts in first 24 h; VAS pain scores and shoulder function by goniometry at 24 h, 14 days (approximately) and 6 months; Verbal Rating Scale pain scores in first 24 h; Brief Pain Inventory and Oxford Shoulder Score at 6 months; duration of hospital stay; incidence of postoperative nausea and vomiting; cost-effectiveness.Ethics and disseminationThe study is approved by the South West England Research Ethics Committee (12/SW/0149).Resultswill be published in a peer-reviewed journal and presented at local, national and international scientific meetings.Trial registrationISRCTN46621916. EudraCT 2011-005775-16.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%