The Role of Muscle Relaxants – Spasmolytic (Thiocochlicoside) in Postoperative Pain Management after Mastectomy and Breast Reconstruction

Abstract

Purpose:Post-operative pain after breast cancer surgery is a major problem and women undergoing mastectomy and breast reconstruction experience post-operative pain syndromes in approximately one-half of all cases. Patients who have undergone breast reconstruction after mastectomy can suffer from acute postoperative pain with moderate or strong tension. In some cases, chronic neuropathic pain syndromes may occur after surgery. Opioids are used to treat pain, with serious side effects. The systemic postoperative analgesic regimen as thiocochlicoside P.O. along with paracetamol and NSAIDs I.V., which may limit the administration of opioids without reducing pain relief, seems to be necessary.Materials and Methods:This study was a clinical trial randomizing 70 patients undergoing breast reconstruction. Two main protocols of systematic post-operative analgesia, one using thiocochlicoside (group A) and the other without them (group B), were used. Both groups received paracetamol X3 and lornoxicam X2 I.V. systematically. The pain measurement scale (NPS) used to measure post-operative pain. Likert scales were used to evaluate patient’s satisfaction and the difficulty from the side effects . An anonymous questionnaire was used for the data collection.Results:Statistically significant difference was found between pain on the day of surgery (p = 0.017) as well as the three subsequent days (p = 0.000). In group A , pain was reduced directly to half (Χ2 surgery pain = 93.888, p = 0.000) especially on the first post-operative day. In group A the satisfaction with analgesic treatment was higher than in group B (p = 0.002).Conclusion:The use of thiocochlicoside in post-operative analgesia in breast reconstruction after mastectomy contributes to reduce the pain intensity experienced by patients and to reduce the side effects of opioid analgesics as a result of reduced demand for opioid analgesics. Patients who received the analgesia using muscle relaxants-spasmolytic reported greater satisfaction.

Prolonged Opioid Use Among Opioid-Naive Women Undergoing Breast Reconstructive Surgery

“…24 Specifically, the use of muscle relaxants has been previously suggested as a means to effectively manage pain following breast reconstruction and reduce the need for opioid analgesics. 25 Our study's findings did not indicate an association between muscle relaxants and prolonged opioid use, and thus muscle relaxants could be considered as part of adjuvant therapy at the provider's discretion. On the other hand, anticonvulsants—particularly gabapentin—have also been previously suggested as adjuvant pain medication therapy; the significantly increased risk of prolonged opioid use in patients also taking anticonvulsant medications in our study is a point of concern.…”

Perioperative Blocks for Decreasing Postoperative Narcotics in Breast Reconstruction

“…This brings attention to nonnarcotic pain medications that can be used intravenously or orally. Examples include IV ketorolac and tramadol, and PO diclofenac and muscle relaxants (58)(59)(60)(61). Lastly, complications due to blocks per se may cause extended hospital stays.…”

Predictive Factors for Postoperative Opioid Use in Elective Skull Base Craniotomies

“…However, direct infiltration of local anesthetic into the muscle may be one option to help reduce immediate postoperative pain. Postoperative muscle relaxers may also benefit patients who undergo surgeries with significant muscle dissection, as suggested by a 2019 study by Bourazani et al 24 in which muscle relaxers reduced postoperative pain and opioid consumption in patients undergoing mastectomies and breast reconstruction procedures. In a meta-analysis conducted by Perera et al, 25 patients who underwent lumbar spine surgery with postoperative anesthetic infiltration into the muscle required less postoperative analgesics and a reduction in postoperative opioid use.…”