1
|
Pereira S, Araújo N, Fontes F, Lopes-Conceição L, Dias T, Ferreira A, Morais S, Cruz VT, Lunet N. Cancer-Related Neuropathic Pain, Chemotherapy-Induced Peripheral Neuropathy and Cognitive Decline in a 5-Year Prospective Study of Patients with Breast Cancer-NEON-BC. Healthcare (Basel) 2023; 11:3132. [PMID: 38132022 PMCID: PMC10743065 DOI: 10.3390/healthcare11243132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
This study aims to estimate the prevalence and to identify the determinants of cancer-related neuropathic pain (CRNP), chemotherapy-induced peripheral neuropathy (CIPN) and cognitive decline among patients with breast cancer over five years after diagnosis. Women with an incident breast cancer (n = 462) and proposed for surgery were recruited at the Portuguese Institute of Oncology-Porto in 2012 and underwent systematic neurological examinations and evaluations with the Montreal Cognitive Assessment (MoCA) before treatment and after one, three, and five years. Multivariate logistic regression was used to assess the determinants of CRNP and CIPN, and multivariate linear regression for the variation in MoCA scores. Prevalence of CRNP and CIPN decreased from the first to the fifth year after diagnosis (CRNP: from 21.1% to 16.2%, p = 0.018; CIPN: from 22.0% to 16.0% among those undergoing chemotherapy, p = 0.007). Cognitive impairment was observed in at least one assessment in 17.7% of the women. Statistically significant associations were observed between: cancer stage III and both CRNP and CIPN; triple negative breast cancer, chemotherapy, axillary node dissection, older age, higher education, and being single and CRNP; taxanes and fruit and vegetable consumption and CIPN. Anxiety, depression and poor sleep quality at baseline were associated with decreases in MoCA values from pre- to post-treatment and with CRNP. Follow-up protocols should consider the persistence of CRNP, CIPN, and cognitive impairment for several years following diagnosis.
Collapse
Affiliation(s)
- Susana Pereira
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal; (S.P.); (F.F.); (S.M.); (V.T.C.); (N.L.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas, 135, 4050-600 Porto, Portugal
- Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal; (T.D.); (A.F.)
| | - Natália Araújo
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal; (S.P.); (F.F.); (S.M.); (V.T.C.); (N.L.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas, 135, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - Filipa Fontes
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal; (S.P.); (F.F.); (S.M.); (V.T.C.); (N.L.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas, 135, 4050-600 Porto, Portugal
- Oncology Nursing Research Unit IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC) & RISE@CI-IPOP (Health Research Network), 4200-072 Porto, Portugal
| | - Luisa Lopes-Conceição
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal; (S.P.); (F.F.); (S.M.); (V.T.C.); (N.L.)
| | - Teresa Dias
- Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal; (T.D.); (A.F.)
| | - Augusto Ferreira
- Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal; (T.D.); (A.F.)
| | - Samantha Morais
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal; (S.P.); (F.F.); (S.M.); (V.T.C.); (N.L.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas, 135, 4050-600 Porto, Portugal
| | - Vítor Tedim Cruz
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal; (S.P.); (F.F.); (S.M.); (V.T.C.); (N.L.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas, 135, 4050-600 Porto, Portugal
| | - Nuno Lunet
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal; (S.P.); (F.F.); (S.M.); (V.T.C.); (N.L.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas, 135, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| |
Collapse
|
2
|
Chiang DLC, Rice DA, Helsby NA, Somogyi AA, Kluger MT. The incidence, impact, and risk factors for moderate to severe persistent pain after breast cancer surgery: a prospective cohort study. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1023-1034. [PMID: 37184910 PMCID: PMC10655209 DOI: 10.1093/pm/pnad065] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Few Australasian studies have evaluated persistent pain after breast cancer surgery. OBJECTIVE To evaluate the incidence, impact, and risk factors of moderate to severe persistent pain after breast cancer surgery in a New Zealand cohort. DESIGN Prospective cohort study. METHODS Consented patients were reviewed at 3 timepoints (preoperative, 2 weeks and 6 months postoperative). Pain incidence and interference, psychological distress and upper limb disability were assessed perioperatively. Clinical, demographic, psychological, cancer treatment-related variables, quantitative sensory testing, and patient genotype (COMT, OPRM1, GCH1, ESR1, and KCNJ6) were assessed as risk factors using multiple logistic regression. RESULTS Of the 173 patients recruited, 140 completed the 6-month follow-up. Overall, 15.0% (n = 21, 95% CI: 9.5%-22.0%) of patients reported moderate to severe persistent pain after breast cancer surgery with 42.9% (n = 9, 95% CI: 21.9%-66.0%) reporting likely neuropathic pain. Pain interference, upper limb dysfunction and psychological distress were significantly higher in patients with moderate to severe pain (P < .004). Moderate to severe preoperative pain (OR= 3.60, 95% CI: 1.13-11.44, P = .03), COMT rs6269 GA genotype (OR = 5.03, 95% CI: 1.49-17.04, P = .009) and psychological distress at postoperative day 14 (OR= 1.08, 95% CI: 1.02-1.16, P = .02) were identified as risk factors. Total intravenous anesthesia (OR= 0.31, 95% CI: 0.10 - 0.99, P = .048) was identified as protective. CONCLUSION The incidence of moderate to severe persistent pain after breast cancer surgery is high with associated pain interference, physical disability, and psychological distress. Important modifiable risk factors were identified to reduce this important condition.
Collapse
Affiliation(s)
- Daniel L C Chiang
- Department of Anaesthesiology, Perioperative & Pain Medicine, Waitemata District Health Board, Auckland, New Zealand
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
- Department of Anaesthesiology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - David A Rice
- Department of Anaesthesiology, Perioperative & Pain Medicine, Waitemata District Health Board, Auckland, New Zealand
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nuala A Helsby
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Andrew A Somogyi
- Discipline of Pharmacology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Michal T Kluger
- Department of Anaesthesiology, Perioperative & Pain Medicine, Waitemata District Health Board, Auckland, New Zealand
- Department of Anaesthesiology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| |
Collapse
|
3
|
Wang M, Xiong HP, Sheng K, Sun XB, Zhao XQ, Liu QR. Perioperative Administration of Pregabalin and Esketamine to Prevent Chronic Pain After Breast Cancer Surgery: A Randomized Controlled Trial. Drug Des Devel Ther 2023; 17:1699-1706. [PMID: 37313456 PMCID: PMC10259464 DOI: 10.2147/dddt.s413273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/02/2023] [Indexed: 06/15/2023] Open
Abstract
Background Perioperative multimodal analgesia can prevent chronic pain after breast cancer surgery. This study aimed to investigate the efficacy of combined perioperative oral pregabalin and postoperative esketamine in preventing chronic pain after breast cancer surgery. Methods Ninety patients undergoing elective breast cancer surgery were randomized into the combined pregabalin and esketamine group (EP group) and the general anesthesia alone group (Control group). The EP group received 150 mg of oral pregabalin 1 h before surgery and twice daily for seven days postoperatively, and a patient-controlled analgesia pump after surgery that delivered 100 μg sufentanil + 1.25 mg/kg esketamine + 4 mg tropisetron in 100 mL saline solution intravenously. The Control group received placebo capsules before and after the surgery and routine postoperative analgesia (100 μg sufentanil + 4 mg tropisetron in 100 mL saline solution). The primary outcome was the incidence of chronic pain three and six months after surgery. Secondary outcomes included acute postoperative pain, postoperative opioid consumption, and incidence of adverse events. Results The incidence of chronic pain in the EP group was significantly lower than in the Control group three (14.3% vs 46.3%, P = 0.005) and six (7.1% vs 31.7%, P = 0.009) months postoperatively. The rest numerical rating scale (NRS) pain scores 1-3 days postoperatively and coughing NRS pain scores 1-7 days postoperatively in the EP group were significantly lower than in the Control group (all P ˂ 0.05). The cumulative sufentanil consumption in the EP group during postoperative 0-12, 12-24, and 24-48, 0-24, and 0-48 hours were significantly lower than in the Control group (all P ˂ 0.05). Conclusion Combined perioperative oral pregabalin and postoperative esketamine effectively prevented chronic pain after breast cancer surgery, improved acute postoperative pain, and reduced postoperative opioid consumption.
Collapse
Affiliation(s)
- Miao Wang
- Department of Anesthesiology, Xishan People’s Hospital of Wuxi City, Wuxi, 214105, People’s Republic of China
| | - Hua-Ping Xiong
- Department of Anesthesiology, Wuxi Maternal and Child Health Hospital, Wuxi School of Medicine, Jiangnan University, Jiangsu, 214002, People’s Republic of China
| | - Kai Sheng
- Department of Anesthesiology, Xishan People’s Hospital of Wuxi City, Wuxi, 214105, People’s Republic of China
| | - Xing-Bing Sun
- Department of Anesthesiology, Xishan People’s Hospital of Wuxi City, Wuxi, 214105, People’s Republic of China
| | - Xiao-Qian Zhao
- Department of Breast Diseases, Wuxi Maternal and Child Health Hospital, Wuxi School of Medicine, Jiangnan University, Jiangsu, 214002, People’s Republic of China
| | - Qing-Ren Liu
- Department of Anesthesiology, Xishan People’s Hospital of Wuxi City, Wuxi, 214105, People’s Republic of China
| |
Collapse
|
4
|
Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15030591. [PMID: 36765547 PMCID: PMC9913127 DOI: 10.3390/cancers15030591] [Citation(s) in RCA: 69] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.
Collapse
|
5
|
Pain prevalence and characteristics in survivors of solid cancers: a systematic review and meta-analysis. Support Care Cancer 2022; 31:85. [PMID: 36574040 DOI: 10.1007/s00520-022-07491-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/07/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE The latest systematic review on the prevalence of pain in cancer survivors was published 5 years ago. The current review aims to provide an extended overview on the prevalence of pain, pain mechanisms, pain characteristics, and assessment methods in cancer survivors. METHODS A systematic research was conducted on 17th of April 2020 using MEDLINE, Embase, Scopus, Web of Science, and Cochrane looking at studies from 2014 to 2020. Studies had to report pain prevalence rates in cancer survivors with a solid tumor who finished curative treatment at least 3 months ago. Methodological quality was assessed by two independent reviewers using the Joanna Briggs Institute quality appraisal tool. Characteristics of the included studies, participants and reported pain prevalence rates were extracted. The reported prevalence rates of the individual studies were pooled within a meta-analysis. Meta-regressions were performed to identify possible determinants of the pooled pain prevalence. RESULTS After deduplication, 7300 articles were screened, after which 38 were included in the meta-analysis. Risk of bias was rated low in 26 articles and moderate in 12 articles. The pooled pain prevalence was 47% (95%CI 39-55), with a heterogeneity of 98.99%. CONCLUSION This meta-analysis suggests that nearly half of cancer survivors report pain after completing curative treatment at least 3 months ago. However, substantial unexplained heterogeneity warrants cautious interpretation of these results. Meta-regression using cancer type, treatment location, pain measurement, and follow-up time as a covariate could not explain influencing factors explaining the high heterogeneity.
Collapse
|
6
|
Cohen CL, Atkins KJ, Evered LA, Silbert BS, Scott DA. Examining Subjective Psychological Experiences of Postoperative Delirium in Older Cardiac Surgery Patients. Anesth Analg 2022; 136:1174-1181. [PMID: 36201368 DOI: 10.1213/ane.0000000000006226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Postoperative delirium (POD) is an acute syndrome including inattention and impaired cognition that affects approximately 42% of older cardiac surgical patients. POD is linked to adverse outcomes including morbidity, mortality, and further cognitive decline. Less is known about the subjective psychological experience of POD and its ongoing impact on well-being. METHODS We performed a qualitative analysis of the long-term psychological sequelae of older adults who experience POD after cardiac surgery. We sampled 30 patients aged 60 years and older who experienced at least 2 episodes of POD during a prior hospital admission. We administered semistructured interviews with participants via telephone 3 to 5 years postoperatively. Interviews were transcribed and thematically analyzed. Data were interpreted in accordance with the naturalist paradigm. RESULTS Three overarching themes emerged in our qualitative analysis. The first reflected the multifaceted presentation of POD, including distortion of time and reality; feelings of isolation; and a loss of self, identity, and control. The second theme reflected the psychological challenges associated with functional decline after surgery. Common examples of functional decline included cognitive difficulties, excessive fatigue, and a perceived loss of independence. The final theme captured the emotional sequelae of acute illness, which included low mood, reduced motivation, and social comparisons. CONCLUSIONS Our findings emphasize the multidimensional experience of POD and long-term effects on psychological wellbeing. Our research highlights the beneficial role multidisciplinary clinicians play in managing POD including strategies that may be embedded into clinical practice and helps anesthesiologists understand why patients who have experienced POD in the past may present with specific concerns should they require subsequent surgery.
Collapse
Affiliation(s)
- Caitlin L Cohen
- From the School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.,Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Kelly J Atkins
- From the School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.,Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Lisbeth A Evered
- Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia.,Weill Cornell Medicine, New York, New York
| | - Brendan S Silbert
- Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - David A Scott
- Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Li X, Li Y. Nerve Block on Pain After Mammaplasty: A Meta-Analysis of randomized controlled studies. Plast Surg (Oakv) 2022; 30:32-38. [PMID: 35096690 PMCID: PMC8793749 DOI: 10.1177/2292550320969648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Nerve block showed some potential in alleviating pain after mammaplasty. This systematic review and meta-analysis was conducted to investigate the efficacy of nerve block for pain control after mammaplasty. METHODS The databases including PubMed, Embase, Web of Science, EBSCO, and Cochrane library databases were systematically searched for collecting the randomized controlled trials (RCTs) regarding the impact of nerve block on pain intensity after mammaplasty. RESULTS This meta-analysis included 4 RCTs. Compared with control group after mammaplasty, nerve block resulted in remarkably reduced pain scores at 1 hour (mean difference [MD] = -1.84; 95% CI = -2.49 to -1.20; P < .00001), 3 hours (MD = -1.04; 95% CI = -1.47 to -0.62; P < .00001), 6 hours (MD = -0.96; 95% CI = -1.48 to -0.43; P = .0004), and analgesic consumption (standard mean difference = -1.27; 95% CI = -1.73 to -0.82; P < .00001), but showed no significant impact on pain scores within 24 hours (MD = -0.31; 95% CI = -1.05 to 0.43; P = .41). CONCLUSIONS Nerve block was associated with substantially reduced pain intensity after mammaplasty.
Collapse
Affiliation(s)
- Xiaoxia Li
- Burn Plastic and Cosmetic Surgery Department, Bayannur City Hospital, Inner Mongolia, People’s Republic of China,Xiaoxia Li, Burn Plastic and Cosmetic Surgery Department, Bayannur City Hospital, No.98, Wulanbuhe Road, Bayannur city, Inner Mongolia 015000, People’s Republic of China.
| | - Ying Li
- Burn Plastic and Cosmetic Surgery Department, Bayannur City Hospital, Inner Mongolia, People’s Republic of China
| |
Collapse
|
8
|
Lee JE, Park YJ, Lee JW. Ropivacaine continuous wound infusion after mastectomy with immediate autologous breast reconstruction: A retrospective observational study. Medicine (Baltimore) 2021; 100:e26337. [PMID: 34128878 PMCID: PMC8213328 DOI: 10.1097/md.0000000000026337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 05/25/2021] [Indexed: 11/26/2022] Open
Abstract
Continuous wound infusion usually provides postoperative analgesia as a multimodal analgesia with systemic opioid use. When continuous wound infusion of local anesthetics (LA) supports successful postoperative analgesia without systemic opioid use, the side effects of opioid can be reduced. Nevertheless, continuous wound infusion after mastectomy with immediate autologous breast reconstruction leads to concerns about wound healing. This study evaluated analgesic effects and wound healing conditions of continuous wound infusion of LA compared with opioid-based, intravenous patient-controlled analgesia (IV PCA) in mastectomy with immediate autologous breast reconstruction.This retrospective observational study included females, aged between 33 and 67 years, who underwent mastectomy with immediate autologous breast reconstruction. Sixty-five patients were enrolled. The eligible patients were placed into 2 groups for managing postoperative pain, one used continuous wound infusion with 0.5% ropivacaine (ON-Q, n = 32) and the other used a fentanyl-based IV PCA (IV PCA, n = 33). Using the electronic medical record system, the postoperative recovery profiles were examined over 5 days using a visual analogue scale (VAS), incidence of postoperative nausea and vomiting (PONV), incidence of sleep disturbance, frequency of rescue analgesic use, analgesia-related adverse events, length of hospital stay, and degree of patient satisfaction. The condition of the surgical wound was observed for 1 year after surgery.The primary endpoint was the intensity of pain at 6 hours after surgery. The VAS was comparable between the groups (P > .05). Although recovery profiles and the degree of patient satisfaction were similar between the groups, the incidence of PONV was significantly lower in the ON-Q group than in the IV PCA group on the day of surgery and postoperative day 1. No patients had severe wound complications. The satisfaction score of analgesia in the ON-Q group was comparable with that of the patients in the IV PCA group.This study demonstrates that single use of continuous wound infusion showed comparable analgesia with fentanyl-based IV PCA in patients who underwent mastectomy with immediate autologous breast reconstruction. Furthermore, the continuous infusion of LA directly on the surgical site did not significantly affect wound healing.
Collapse
Affiliation(s)
| | | | - Jeong Woo Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| |
Collapse
|
9
|
Villa G, Mandarano R, Scirè-Calabrisotto C, Rizzelli V, Del Duca M, Montin DP, Paparella L, De Gaudio AR, Romagnoli S. Chronic pain after breast surgery: incidence, associated factors, and impact on quality of life, an observational prospective study. Perioper Med (Lond) 2021; 10:6. [PMID: 33622393 PMCID: PMC7903732 DOI: 10.1186/s13741-021-00176-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic pain after breast surgery (CPBS) has a disabling impact on postoperative health status. Mainly because of the lack of a clear definition, inconsistency does exist in the literature concerning both the actual incidence and the risk factors associated to CPBS. The aim of this prospective, observational study is to describe the incidence of and risk factors for CPBS, according to the definition provided by the IASP taskforce. The impact of CPBS on patients' function and quality of life is also described. METHODS Women aged 18+ undergoing oncological or reconstructive breast surgery from Jan until Apr 2018 at the Breast Unit of Careggi Hospital (Florence, Italy) were prospectively observed. Postoperative pain was measured at 0 h, 3 h, 6 h, 12 h, 24 h, 48 h, and 3 months (CPBS) after surgery. Preoperative, intraoperative, and postoperative factors were compared in CPBS and No-CPBS groups through multivariate logistic regression analysis. RESULTS Among the 307 patients considered in this study, the incidence of CPBS was 28% [95% CI 23.1-33.4%]. Results from the logistic regression analysis suggest that axillary surgery (OR [95% CI], 2.99 [1.13-7.87], p = 0.03), preoperative use of pain medications (OR [95% CI], 2.04 [1.20-3.46], p = 0.01), and higher dynamic NRS values at 6 h postoperatively (OR [95% CI], 1.28 [1.05-1.55], p = 0.01) were all independent predictors for CPBS. CONCLUSIONS Chronic pain after breast surgery is a frequent complication. In our cohort, long-term use of analgesics for pre-existing chronic pain, axillary surgery, and higher dynamic NRS values at 6 h postoperatively were all factors associated with increased risk of developing CPBS. The possibility to early detect persistent pain, particularly in those patients at high risk for CPBS, might help physicians to more effectively prevent pain chronicisation. TRIAL REGISTRATION ClinicalTrials.gov registration NCT04309929 .
Collapse
Affiliation(s)
- Gianluca Villa
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy.
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla,3, Florence, 50100, Italy.
| | - Raffaele Mandarano
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Caterina Scirè-Calabrisotto
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Valeria Rizzelli
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Martina Del Duca
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Diego Pomarè Montin
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Laura Paparella
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla,3, Florence, 50100, Italy
| | - A Raffaele De Gaudio
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla,3, Florence, 50100, Italy
| | - Stefano Romagnoli
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla,3, Florence, 50100, Italy
| |
Collapse
|
10
|
Zhang L, Ding W, Ji Y. Analgesic effect of pulsed electromagnetic fields for mammaplasty: A meta-analysis of randomized controlled studies. Medicine (Baltimore) 2020; 99:e21449. [PMID: 32871867 PMCID: PMC7458251 DOI: 10.1097/md.0000000000021449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pulsed electromagnetic fields shows some potential in alleviating pain after mammaplasty. This systematic review and meta-analysis is conducted to investigate the analgesic efficacy of pulsed electromagnetic fields for pain control after mammaplasty. METHODS The databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases are systematically searched for collecting the randomized controlled trials regarding the impact of pulsed electromagnetic fields on pain intensity after mammaplasty. RESULTS This meta-analysis has included 4 randomized controlled trials. Compared with control group after mammaplasty, pulsed electromagnetic fields results in remarkably reduced pain scores on 1 day (MD = -1.34; 95% confidence interval [CI] = -2.23 to -0.45; P = .003) and 3 days (MD = -1.86; 95% CI = -3.23 to -0.49; P = .008), as well as analgesic consumption (Std. MD = -5.64; 95% CI = -7.26 to -4.02; P < .00001). CONCLUSIONS Pulsed electromagnetic fields is associated with substantially reduced pain intensity after mammaplasty.
Collapse
Affiliation(s)
- Li Zhang
- Department of Plastic Surgery, The First people's Hospital of Xiaoshan
| | - Wei Ding
- Department of Plastic Surgery, The First people's Hospital of Xiaoshan
| | - Yu Ji
- Department of Plastic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou; Zhejiang Province, P.R. China
| |
Collapse
|
11
|
Abstract
Multimodal pain management of cardiac surgical patients is a paradigm shift in postoperative care. This promising approach features complementary medications and techniques that spare opioids and improves symptomatic and functional recovery. Although the specific elements remain to be defined, the collaboration of the health care team and patient and continuous iterative programmatic improvements are important pillars of this approach.
Collapse
|
12
|
Besic N, Smrekar J, Strazisar B. Chronic adverse effects after an axillary lymphadenectomy in breast cancer patients after administering weaker and stronger postoperative analgesia: results of a prospective double-blind randomized study. Breast Cancer Res Treat 2020; 182:655-663. [PMID: 32557338 DOI: 10.1007/s10549-020-05713-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/26/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim of this study was to compare the rate of chronic adverse effects after a weaker and stronger postoperative analgesia. METHODS A prospective double-blind randomized study included 117 breast cancer patients receiving tramadol for pain relief for 4 weeks after an axillary lymphadenectomy from 2015 to 2018. Patients with a larger dose received 75/650 mg of tramadol with paracetamol every 8 h and a group with a lower dose received 37.5/325 mg of tramadol with paracetamol every 8 h from the 2nd to the 29th postoperative day. 1 year after surgery, patients were evaluated for the presence of neuropathic pain, chronic pain, arm symptoms and lymphedema. RESULTS There was a trend for a lower rate of neuropathic pain after stronger analgesia in comparison to weaker analgesia (p = 0.059). Chronic pain was present in 18% of patients 1 year after the lymphadenectomy. There was no difference in the rate of chronic pain after stronger and weaker postoperative analgesia. Patients had less arm symptoms after a stronger analgesia than after a weaker analgesia (p = 0.02). Furthermore, there was a trend for a lower rate of lymphedema of the forearm after a stronger analgesia than after a lower analgesia (p = 0.078). CONCLUSIONS The patients who received a stronger postoperative analgesia had less arm symptoms and a better quality of life in comparison to patients who received a weaker analgesia. The patients who received a stronger postoperative analgesia had a statistical trend for less neuropathic pain in comparison to patients who received a weaker analgesia.
Collapse
Affiliation(s)
- Nikola Besic
- Department of Surgical Oncology, Institute of Oncology, Zaloska 2, 1000, Ljubljana, Slovenia.
| | - Jaka Smrekar
- Faculty of Mathematics and Physics, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Branka Strazisar
- Department of Anesthesiology, Institute of Oncology, Zaloska 2, 1000, Ljubljana, Slovenia
| |
Collapse
|
13
|
Cai L, Li Z, Liu L, Cao D, Li K, Li Y, Wang D. The efficacy of nerve block for pain control after mammaplasty: a meta-analysis of randomized controlled studies. J Plast Surg Hand Surg 2020; 54:195-199. [PMID: 32530351 DOI: 10.1080/2000656x.2019.1661847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Nerve block shows some potential in alleviating pain after mammaplasty. This systematic review and meta-analysis aims to investigate the efficacy of nerve block for pain control after mammaplasty.Methods: The databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases are systematically searched for collecting the randomized controlled trials (RCTs) regarding the impact of nerve block on pain intensity after mammaplasty.Results: This meta-analysis has included four RCTs. Compared with the control group after mammaplasty, nerve block results in remarkably reduced pain scores. At 1, 3, and 6 h, the scores are -1.84; -2.49 to -1.20 (mean difference (MD; 95% confidence interval (CI)); p < .00001, -1.04; -1.47 to -0.62; p < .00001; and -0.96; -1.48 to -0.43; p = .0004, respectively. At 24 h, nerve block shows no significant impact on pain scores: 0.31; -1.05 to 0.43; p = .41. The standard MD of analgesic consumption is significantly reduced after nerve block: -1.27; -1.73 to -0.82; p < .00001.Conclusions: Nerve block is associated with substantially reduced pain intensity at 1 h, 3 h, and 6 h, as well as decreased analgesic consumption after mammaplasty. Therefore, a nerve block is a valuable tool for postoperative care after mammaplasty and should be recommended for the surgery.
Collapse
Affiliation(s)
- Limin Cai
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, China
| | - Zhiwen Li
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, China
| | - Lingyun Liu
- Department of Andrology, The First Hospital of Jilin University, Changchun, China
| | - Dongdong Cao
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, China
| | - Kuiliang Li
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, China
| | - Ying Li
- Department of Andrology, The First Hospital of Jilin University, Changchun, China
| | - Dunwei Wang
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
14
|
Sun Q, Liu S, Wu H, Kang W, Dong S, Cui Y, Pan Z, Liu K. Clinical analgesic efficacy of pectoral nerve block in patients undergoing breast cancer surgery: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e19614. [PMID: 32243387 PMCID: PMC7440076 DOI: 10.1097/md.0000000000019614] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Breast cancer is the most commonly diagnosed cancer in women, and more than half of breast surgery patients experience severe acute postoperative pain. This meta-analysis is designed to examine the clinical analgesic efficacy of Pecs block in patients undergoing breast cancer surgery. METHODS An electronic literature search of the Library of PubMed, EMBASE, Cochrane Library, and Web of Science databases was conducted to collect randomized controlled trials (RCTs) from inception to November 2018. These RCTs compared the effect of Pecs block in combination with general anesthesia (GA) to GA alone in mastectomy surgery. Pain scores, intraoperative and postoperative opioid consumption, time to first request for analgesia, and incidence of postoperative nausea and vomiting were analyzed. RESULTS Thirteen RCTs with 940 patients were included in our analysis. The use of Pecs block significantly reduced pain scores in the postanesthesia care unit (weighted mean difference [WMD] = -1.90; 95% confidence interval [CI], -2.90 to -0.91; P < .001) and at 24 hours after surgery (WMD = -1.01; 95% CI, -1.64 to -0.38; P < .001). Moreover, Pecs block decreased postoperative opioid consumption in the postanesthesia care unit (WMD = -1.93; 95% CI, -3.51 to -0.34; P = .017) and at 24 hours (WMD = -11.88; 95% CI, -15.50 to -8.26; P < .001). Pecs block also reduced intraoperative opioid consumption (WMD = -85.52; 95% CI, -121.47 to -49.56; P < .001) and prolonged the time to first analgesic request (WMD = 296.69; 95% CI, 139.91-453.48; P < .001). There were no statistically significant differences in postoperative nausea and vomiting and block-related complications. CONCLUSIONS Adding Pecs block to GA procedure results in lower pain scores, less opioid consumption and longer time to first analgesic request in patients undergoing breast cancer surgery compared to GA procedure alone.
Collapse
Affiliation(s)
| | | | - Huiying Wu
- Department of Ultrasonic Diagnosis, The Second Hospital of Jilin University, Changchun
| | - Wenyue Kang
- Department of Anesthesiology, Hainan Provincial People's Hospital, Hainan
| | | | | | | | - Kexiang Liu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, China
| |
Collapse
|
15
|
Masgoret P, de Soto I, Caballero Á, Ríos J, Gomar C. Incidence of contralateral neurosensitive changes and persistent postoperative pain 6 months after mastectomy: A prospective, observational investigation. Medicine (Baltimore) 2020; 99:e19101. [PMID: 32176037 PMCID: PMC7440329 DOI: 10.1097/md.0000000000019101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mirror image sensory dysfunction (MISD) after breast surgery has not yet been studied. This prospective observational study aimed to determine the incidence of MISD, persistent postoperative pain (PPP) and mirror image pain (MIP) during 6 months after total unilateral mastectomy.Visual analogue scale (VAS), Neuropathic Pain Symptom Inventory (NPSI), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Life orientation test (LOT) and Quantitative Sensory Testing (QST) (in ipsi and contralateral breast, axilla and thigh) were recorded. VAS > 3 at 1, 3, and 6 postoperative months was considered PPP. Contralateral changes of QST at any time was considered indicative of MISD and spontaneous contralateral VAS ≥ 1 as MIP.Sixty-four patients were included. PPP at 1, 3 and 6 months was 18.8%, 56.2%, and 21.3%, respectively Ten patients presented MIP. MISD was detected in 79.7% patients in contralateral breast and 62.5% in contralateral axilla. Furthermore, changes in QST were present in 39.1% of patients in thigh. Electronic Von Frey (EVF) changes in both contralateral breast and axilla, and in thigh significantly diminished at all postoperative times. Changes of postoperative EVF ≥ 20% in contralateral breast were associated to higher VAS values. NPSI scores were significantly higher at all postoperative times. At 1 month, PCS, depression HADS subscale and LOT scores were significantly worse than all the other periods.MISD incidence was almost 80%, and 15.6% of patients showed spontaneous contralateral VAS ≥ 1. At 6 months 21.3% of patients manifested PPP. The worst alteration of factors related to PPP occurred at 1 postoperative month. Most consistent QST was EVF.
Collapse
Affiliation(s)
- Paula Masgoret
- Department of Anesthesiology, Hospital Clinic, University of Barcelona
| | - Inés de Soto
- Department of Anesthesiology, Consorci Sanitari Parc Taulí de Sabadell
| | - Ángel Caballero
- Department of Anesthesiology, Hospital Clinic, University of Barcelona
| | - José Ríos
- Laboratory of Biostatistics and Epidemiology, Universitat Autonoma de Barcelona, Biostatistics and Data Management Platform, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Carmen Gomar
- Department of Anesthesiology, Hospital Clinic, University of Barcelona
| |
Collapse
|
16
|
Chronic postsurgical pain and cancer: the catch of surviving the unsurvivable. Curr Opin Support Palliat Care 2019; 12:118-123. [PMID: 29553987 DOI: 10.1097/spc.0000000000000341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Chronic postsurgical pain (CPSP) is an important and well recognized cause of much long-term suffering, which in some cases may be preventable and affects many people living with cancer. Unfortunately, general consensus is lacking as to how best reduce the risk of developing CPSP. RECENT FINDINGS Cancer is now not always a short-lived, fatal disease and is now moving towards a chronic illness. Poorly managed perioperative pain is the greatest risk factor for CPSP. Recent trials have examined preventive strategies for CPSP associated with breast surgery and thoracotomy, two operations used in cancer treatment. Standard antinociceptive drugs, 5% lidocaine patches and ketamine do not prevent CPSP. The evidence for gabapentinoids is conflicting. Intravenous lidocaine and, separately, regional anaesthesia appear beneficial. SUMMARY Well-managed pain, irrespective of technique, reduces the risk of CPSP. The literature is inconclusive regarding an 'optimal approach.' Regional anaesthesia, intravenous lidocaine and the aggressive management of perioperative pain using multimodal analgesia including antineuropathic pain agents such as gabapentinoids and certain antidepressants are recommended. Clinicians should not rely on general anaesthesia, opioids, NSAIDs and ketamine to prevent CPSP. A blanket approach using gabapentinoids for all patients undergoing major surgery is not indicated. Instead, the presence of perioperative neuropathic pain should be checked for regularly.
Collapse
|
17
|
Abstract
Chronic postsurgical pain affects between 5 and 75% of patients, often with an adverse impact on quality of life. While the transition of acute to chronic pain is a complex process-involving multiple mechanisms at different levels-the current strategies for prevention have primarily been restricted to perioperative pharmacological interventions. In the present paper, we first present an up-to-date narrative literature review of these interventions. In the second section, we develop several ways by which we could overcome the limitations of the current approaches and enhance the outcome of our surgical patients, including the better identification of individual risk factors, tailoring treatment to individual patients, and improved acute and subacute pain evaluation and management. The third and final section covers the treatment of established CPSP. Given that evidence for the current therapeutic options is limited, we need high-quality trials studying multimodal interventions matched to pain characteristics.
Collapse
Affiliation(s)
- Arnaud Steyaert
- Department of Anesthesiology, Acute and Transitional Pain Service, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Patricia Lavand'homme
- Department of Anesthesiology, Acute and Transitional Pain Service, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| |
Collapse
|
18
|
Wang K, Yee C, Tam S, Drost L, Chan S, Zaki P, Rico V, Ariello K, Dasios M, Lam H, DeAngelis C, Chow E. Prevalence of pain in patients with breast cancer post-treatment: A systematic review. Breast 2018; 42:113-127. [DOI: 10.1016/j.breast.2018.08.105] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/08/2018] [Accepted: 08/27/2018] [Indexed: 12/12/2022] Open
|
19
|
Ilhan E, Chee E, Hush J, Moloney N. The prevalence of neuropathic pain is high after treatment for breast cancer: a systematic review. Pain 2018; 158:2082-2091. [PMID: 28797014 DOI: 10.1097/j.pain.0000000000001004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pain is common, but often poorly managed after breast cancer treatment. Screening questionnaires and the Neuropathic Pain Special Interest Group (NeuPSIG) criteria are 2 clinical approaches used to determine whether pain has neuropathic components, which may enable better pain management. The aims of this review were (1) to synthesise data from the literature on neuropathic pain prevalence in women after breast cancer treatment; (2) to investigate whether the prevalence of neuropathic pain differed between studies using screening questionnaires and the NeuPSIG criteria. We searched for studies that administered a validated neuropathic pain screening questionnaire and/or the NeuPSIG criteria to women treated for early-stage (I-III) breast cancer. Thirteen studies using screening questionnaires (N = 3792) and 3 studies using components of the NeuPSIG criteria (N = 621) were included. Meta-analyses were conducted for questionnaire data but not for NeuPSIG criteria data because of inadequate homogeneity. Among all participants treated for early-stage breast cancer, pooled prevalence estimates (95% confidence interval) ranged between 14.2% (8.3-21.4) and 27.2% (24.7-88.4) for studies using screening questionnaires; studies using NeuPSIG criteria reported prevalence rates from 24.1% to 31.3%. Among those who reported pain after treatment, the pooled prevalence estimate (95% confidence interval) of neuropathic pain from screening questionnaires ranged from 32.6% (24.2-41.6) to 58.2% (24.7-88.4); studies using NeuPSIG criteria reported prevalence rates from 29.5% to 57.1%. These prevalence estimates are higher than those reported for other types of cancer, and emphasise the need to assess the contribution of neuropathic pain after breast cancer treatment. TRIAL REGISTRATION PROSPERO registration CRD42015029987.
Collapse
Affiliation(s)
- Emre Ilhan
- Faculty of Medicine and Health Sciences, Department of Health Professions, Macquarie University, Sydney, Australia
| | | | | | | |
Collapse
|
20
|
Matsumoto M, Flores EM, Kimachi PP, Gouveia FV, Kuroki MA, Barros ACSD, Sampaio MMC, Andrade FEM, Valverde J, Abrantes EF, Simões CM, Pagano RL, Martinez RCR. Benefits in radical mastectomy protocol: a randomized trial evaluating the use of regional anesthesia. Sci Rep 2018; 8:7815. [PMID: 29777144 PMCID: PMC5959858 DOI: 10.1038/s41598-018-26273-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/08/2018] [Indexed: 12/24/2022] Open
Abstract
Surgery is the first-line treatment for early, localized, or operable breast cancer. Regional anesthesia during mastectomy may offer the prevention of postoperative pain. One potential protocol is the combination of serratus anterior plane block (SAM block) with pectoral nerve block I (PECS I), but the results and potential benefits are limited. Our study compared general anesthesia with or without SAM block + PECS I during radical mastectomy with axillary node dissection and breast reconstruction using evaluations of pain, opioid consumption, side effects and serum levels of interleukin (IL)-1beta, IL-6 and IL-10. This is a prospective, randomized controlled trial. Fifty patients were randomized to general anesthesia only or general anesthesia associated with SAM block + PECS I (25 per group). The association of SAM block + PECS I with general anesthesia reduced intraoperative fentanyl consumption, morphine use and visual analog pain scale scores in the post-anesthetic care unit (PACU) and at 24 h after surgery. In addition, the anesthetic protocol decreased side effects and sedation 24 h after surgery compared to patients who underwent general anesthesia only. IL-6 levels increased after the surgery compared to baseline levels in both groups, and no differences in IL-10 and IL-1 beta levels were observed. Our protocol improved the outcomes of mastectomy, which highlight the importance of improving mastectomy protocols and focusing on the benefits of regional anesthesia.
Collapse
Affiliation(s)
- Marcio Matsumoto
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil.,Sao Paulo Servicos Medicos de Anestesia, Rua Adma Jafet, Jafet, 91 - Bela Vista, São Paulo - SP, 01308-050, Sao Paulo, Brazil
| | - Eva M Flores
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil.,Sao Paulo Servicos Medicos de Anestesia, Rua Adma Jafet, Jafet, 91 - Bela Vista, São Paulo - SP, 01308-050, Sao Paulo, Brazil
| | - Pedro P Kimachi
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil.,Sao Paulo Servicos Medicos de Anestesia, Rua Adma Jafet, Jafet, 91 - Bela Vista, São Paulo - SP, 01308-050, Sao Paulo, Brazil
| | - Flavia V Gouveia
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil
| | - Mayra A Kuroki
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil
| | - Alfredo C S D Barros
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil
| | - Marcelo M C Sampaio
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil
| | - Felipe E M Andrade
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil
| | - João Valverde
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil.,Sao Paulo Servicos Medicos de Anestesia, Rua Adma Jafet, Jafet, 91 - Bela Vista, São Paulo - SP, 01308-050, Sao Paulo, Brazil
| | - Eduardo F Abrantes
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil
| | - Claudia M Simões
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil.,Sao Paulo Servicos Medicos de Anestesia, Rua Adma Jafet, Jafet, 91 - Bela Vista, São Paulo - SP, 01308-050, Sao Paulo, Brazil
| | - Rosana L Pagano
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil
| | - Raquel C R Martinez
- Hospital Sirio-Libanes, Rua Professor Daher Cutait, 69, 01308-060, Sao Paulo, Brazil.
| |
Collapse
|
21
|
Kamel EZ, Abd-Elshafy SK, Sayed JA, Mostafa MM, Seddik MI. Pain alleviation in patients undergoing cardiac surgery; presternal local anesthetic and magnesium infiltration versus conventional intravenous analgesia: a randomized double-blind study. Korean J Pain 2018; 31:93-101. [PMID: 29686807 PMCID: PMC5904353 DOI: 10.3344/kjp.2018.31.2.93] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/17/2018] [Accepted: 02/18/2018] [Indexed: 11/05/2022] Open
Abstract
Background Magnesium is one of the effective, safe local anesthetic adjuvants that can exert an analgesic effect in conditions presenting acute and chronic post-sternotomy pain. We studied the efficacy of continuous infusion of presternal magnesium sulfate with bupivacaine for pain relief following cardiac surgery. Methods Ninety adult patients undergoing valve replacement cardiac surgery randomly allocated into three groups. In all patients; a presternal catheter was placed for continuous infusion of either 0.125% bupivacaine and 5% magnesium sulfate (3 ml/h for 48 hours) in group 1, or 0.125% bupivacaine only in the same rate in group 2, versus conventional intravenous paracetamol and ketorolac in group 3. Rescue analgesia was iv 25 µg fentanyl. Postoperative Visual Analog Scale (VAS) and fentanyl consumption during the early two postoperative days were assessed. All patients were followed up over two months for occurrence of chronic post-sternotomy pain. Results VAS values showed high significant differences during the first 48 hours with the least pain scale in group 1 and significantly least fentanyl consumption (30.8 ± 7 µg in group 1 vs. 69 ± 18 µg in group 2, and 162 ± 3 in group 3 respectively). The incidence of chronic pain has not differed between the three groups although it was more pronounced in group 3. Conclusions Continuous presternal bupivacaine and magnesium infusion resulted in better postoperative analgesia than both presternal bupivacaine alone or conventional analgesic groups.
Collapse
Affiliation(s)
- Emad Zarief Kamel
- Department of Anesthesia, ICU, and Pain, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sayed Kaoud Abd-Elshafy
- Department of Anesthesia, ICU, and Pain, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Jehan Ahmed Sayed
- Department of Anesthesia, ICU, and Pain, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Mohamed Ismail Seddik
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| |
Collapse
|
22
|
Intraoperative Nerve Blocks Fail to Improve Quality of Recovery after Tissue Expander Breast Reconstruction. Plast Reconstr Surg 2018; 141:590-597. [DOI: 10.1097/prs.0000000000004104] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
23
|
Kendall MC, Castro Alves LJ. Reconstructive surgery and persistent postsurgical pain after mastectomy. Breast 2018; 38:188. [PMID: 29395982 DOI: 10.1016/j.breast.2018.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022] Open
Affiliation(s)
- Mark C Kendall
- Department of Anesthesiology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, United States.
| | - Lucas J Castro Alves
- Department of Anesthesiology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, United States
| |
Collapse
|
24
|
Mauermann E, Ruppen W, Bandschapp O. Different protocols used today to achieve total opioid-free general anesthesia without locoregional blocks. Best Pract Res Clin Anaesthesiol 2017; 31:533-545. [DOI: 10.1016/j.bpa.2017.11.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 08/08/2017] [Accepted: 11/08/2017] [Indexed: 12/20/2022]
|
25
|
De Oliveira GS, Bialek J, Rodes ME, Kendall MC, McCarthy RJ. The effect of sevoflurane compared to propofol maintenance on post-surgical quality of recovery in patients undergoing an ambulatory gynecological surgery: A prospective, randomized, double-blinded, controlled, clinical trial. J Clin Anesth 2017; 43:70-74. [PMID: 29032007 DOI: 10.1016/j.jclinane.2017.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 10/06/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The main objective of the current investigation was to evaluate the effect of propofol used as anesthetic maintenance compared to sevoflurane on global post-surgical quality of recovery in female patients undergoing ambulatory gynecological surgery. DESIGN The study was a prospective randomized double blinded, controlled, clinical trial. INTERVENTIONS Healthy female subjects were randomized to receive propofol or sevoflurane as anesthetic maintenance. MEASUREMENTS The primary outcome was the Quality of Recovery 40 (QOR-40) questionnaire at 24h after surgery. Other data collected included opioid consumption, pain scores and time to hospital discharge. P<0.05 was used to reject the null hypothesis for the primary outcome. MAIN RESULTS Ninety subjects were randomized and sixty seven completed the study. Patient's baseline characteristics and surgical factors were not different between study groups. There was not a clinically significant difference in the global QoR-40 scores between the sevoflurane and the propofol groups, median (IQR) of 175 (163 to 181) and 176 (163 to 184), respectively, P=0.97. There was an inverse relationship (ρ=-0.42) between the opioid consumption in PACU (IV morphine equivalents) and 24h postoperative quality of recovery (P<0.001) and an inverse relationship (ρ=-0.48) between the oral opioid consumption at home (oral morphine equivalents) and 24h postoperative quality of recovery, P<0.001. CONCLUSIONS Our current results do not support the use of total intravenous anesthesia as an efficacious strategy to improve global quality of recovery after ambulatory surgery. Opioid consumption in the PACU is an earlier surrogate that can be utilized to identify ambulatory patients with a high likelihood to develop poor global quality of recovery and who may benefit from more efficacious strategies to improve global quality of recovery. TRIAL REGISTRATION ClinicalTrial.gov; url: http://www.clinicaltrials.gov; registration identified: NCT 01755234.
Collapse
Affiliation(s)
- Gildasio S De Oliveira
- Department of Anesthesiology, Rhode Island Hospital, Brown University, Providence, RI, USA; Department of Surgery, Alpert School of Medicine, Brown University, United States; Department of Health Services Research, Practice and Policy, The School of Public health, Brown University, United States.
| | - Jane Bialek
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Meghan E Rodes
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mark C Kendall
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Robert J McCarthy
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
26
|
Kendall MC, McCarthy RJ, Panaro S, Goodwin E, Bialek JM, Nader A, De Oliveira GS. The Effect of Intraoperative Systemic Lidocaine on Postoperative Persistent Pain Using Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials Criteria Assessment Following Breast Cancer Surgery: A Randomized, Double-Blind, Placebo-Cont. Pain Pract 2017; 18:350-359. [DOI: 10.1111/papr.12611] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/01/2017] [Accepted: 07/01/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Mark C. Kendall
- Anesthesiology Department; Feinberg School of Medicine; Northwestern University; Chicago Illinois U.S.A
| | - Robert J. McCarthy
- Anesthesiology Department; Feinberg School of Medicine; Northwestern University; Chicago Illinois U.S.A
| | - Steve Panaro
- Anesthesiology Department; Alpert School of Medicine; Rhode Island Hospital; Brown University; Providence Rhode Island U.S.A
| | - Emily Goodwin
- Anesthesiology Department; Alpert School of Medicine; Rhode Island Hospital; Brown University; Providence Rhode Island U.S.A
| | - Jane M. Bialek
- Anesthesiology Department; Feinberg School of Medicine; Northwestern University; Chicago Illinois U.S.A
| | - Antoun Nader
- Anesthesiology Department; Feinberg School of Medicine; Northwestern University; Chicago Illinois U.S.A
| | - Gildasio S. De Oliveira
- Anesthesiology Department; Alpert School of Medicine; Rhode Island Hospital; Brown University; Providence Rhode Island U.S.A
| |
Collapse
|
27
|
Leysen L, Beckwée D, Nijs J, Pas R, Bilterys T, Vermeir S, Adriaenssens N. Risk factors of pain in breast cancer survivors: a systematic review and meta-analysis. Support Care Cancer 2017; 25:3607-3643. [DOI: 10.1007/s00520-017-3824-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/03/2017] [Indexed: 01/29/2023]
|
28
|
Kumar A, Bullock WM, Dooley J. Use of local anesthetic a key tenet in multimodal analgesia to modulate chronic post-mastectomy pain. J Clin Anesth 2017; 38:26. [PMID: 28372669 DOI: 10.1016/j.jclinane.2017.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/30/2016] [Accepted: 01/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Amanda Kumar
- Department of Anesthesiology, Duke University Medical Center
| | | | - Joshua Dooley
- Department of Anesthesiology, Duke University Medical Center.
| |
Collapse
|
29
|
Effects of systemic lidocaine versus magnesium administration on postoperative functional recovery and chronic pain in patients undergoing breast cancer surgery: A prospective, randomized, double-blind, comparative clinical trial. PLoS One 2017; 12:e0173026. [PMID: 28253307 PMCID: PMC5333858 DOI: 10.1371/journal.pone.0173026] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 02/14/2017] [Indexed: 02/03/2023] Open
Abstract
Introduction We aimed to compare the effects of intraoperative lidocaine and magnesium on postoperative functional recovery and chronic pain after mastectomy due to breast cancer. Systemic lidocaine and magnesium reduce pain hypersensitivity to surgical stimuli; however, their effects after mastectomy have not been evaluated clearly. Methods In this prospective, double-blind, clinical trial, 126 female patients undergoing mastectomy were randomly assigned to lidocaine (L), magnesium (M), and control (C) groups. Lidocaine and magnesium were administered at 2 mg/kg and 20 mg/kg for 15 minutes immediately after induction, followed by infusions of 2 mg/kg/h and 20 mg/kg/h, respectively. The control group received the same volume of saline. Patient characteristics, perioperative parameters, and postoperative recovery profiles, including the Quality of Recovery 40 (QoR-40) survey, pain scales, length of hospital stay, and the short-form McGill pain questionnaire (SF-MPQ) at postoperative 1 month and 3 months were evaluated. Results The global QoR-40 scores on postoperative day 1 were significantly higher in group L than in group C (P = 0.003). Moreover, in sub-scores of the QoR-40 dimensions, emotional state and pain scores were significantly higher in group L than those in groups M and C (P = 0.027 and 0.023, respectively). At postoperative 3 months, SF-MPQ and SF-MPQ-sensitive scores were significantly lower in group L than in group C (P = 0.046 and 0.036, respectively). Conclusions Intraoperative infusion of lidocaine improved the quality of recovery and attenuated the intensity of chronic pain in patients undergoing breast cancer surgery.
Collapse
|