Role of wound instillation with bupivacaine through surgical drains for postoperative analgesia in modified radical mastectomy

Abstract

Background and Aims:Modified Radical Mastectomy (MRM) is the commonly used surgical procedure for operable breast cancer, which involves extensive tissue dissection. Therefore, wound instillation with local anaesthetic may provide better postoperative analgesia than infiltration along the line of incision. We hypothesised that instillation of bupivacaine through chest and axillary drains into the wound may provide postoperative analgesia.Methods:In this prospective randomised controlled study 60 patients aged 45–60 years were divided into three groups. All patients were administered general anaesthesia. At the end of the surgical procedure, axillary and chest wall drains were placed before closure. Group C was the control with no instillation; Group S received 40 ml normal saline, 20 ml through each drain; and Group B received 40 ml of 0.25% bupivacaine and the drains were clamped for 10 min. After extubation, pain score for both static and dynamic pain was evaluated using visual analog scale and then 4th hourly till 24 h. Rescue analgesia was injection tramadol, if the pain score exceeds 4. Statistical analysis was performed using SPSS version 13.Results:There was a significant difference in the cumulative analgesic requirement and the number of analgesic demands between the groups (P: 0.000). The mean duration of analgesia in the bupivacaine group was 14.6 h, 10.3 in the saline group and 4.3 h in the control group.Conclusion:Wound instillation with local anaesthetics is a simple and effective means of providing good analgesia without any major side-effects.

A Comparative Study of Bupivacaine Vs Ropivacaine Wound Instillation through Surgical Drain for Postoperative Analgesia in Modified Radical Mastectomy

“…The optimal dose of bupivacaine or ropivacaine for instillation during mastectomy is also inconclusive. Jonavithulla N. et al in their study concluded that a volume of 40 cc of local anaesthetic solution when instilled through two drains was associated with more complete spread of the drug and good pain relief postoperatively 10 On the other hand the studies using 20 cc volume of the drug showed ineffective pain relief after instillation through a single drain. 11 Hence in our study the drug volume of total 40cc was instilled through two surgical drains, one in the axilla and one in the chest wall, 20 cc each.…”

<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

“…The technique was simple and effective in reducing postoperative pain and no technique-related complications were found. 88 As regards the development of chronic postoperative pain, a qualitative systematic review that included 10 trials and 699 patients and a meta-analysis that analyzed 13 trials with 1150 patients confirm that continuous wound infiltration has an analgesic effect only in the first hours after surgery. 90,91 Similar results were shown by the multicenter study of Albi-Feldzer et al, who evaluated the efficacy in postoperative pain control, the incidence of chronic postoperative pain and its consequences on quality of life and mood comparing the efficacy of preoperative infiltration of the wound at second and third intercostal spaces and at the humeral insertion of major pectoralis with placebo in 236 patients.…”

“…87 Even delivering LAs through the surgical drain may have some advantages. 88,89 Jonnavithula et al compared the instillation of 0.25% bupivacaine 40 mL (20 mL through each of the drain) with placebo. The drains were clamped for a period of 10 min after the drug administration.…”

Effect of Topical Morphine on Acute and Chronic Postmastectomy Pain

“…11 Topical application of local anesthetics or analgesic drugs into the mastectomy wound is a simple, yet effective technique that has been recently investigated. 12,13 It has been demonstrated that exogenous as well as endogenous opioid agonists have peripheral antinociceptive effects in inflamed tissues. 14,15 We hypothesized that the topical application of morphine/ bupivacaine combination would improve the quality of postoperative pain control, thereby decreasing the probability of developing chronic pain afterward.…”