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Kataria M, Gupta N, Kumar A, Bhoriwal S, Singh A, Shekhar V, Bhatia R. Assessing the effectiveness of high frequency repetitive transcranial magnetic stimulation for post-mastectomy pain in breast cancer patients: A randomized controlled trial. Breast Cancer 2024:10.1007/s12282-024-01598-y. [PMID: 38796817 DOI: 10.1007/s12282-024-01598-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Post-mastectomy pain Syndrome (PMPS), characterized by chronic neuropathic pain stemming from intercostobrachial nerve lesions, presents a formidable clinical challenge. With the incidence of breast cancer surging, effective interventions for PMPS are urgently needed. To address this, we conducted this double-blind, placebo-controlled, randomized clinical trial to study the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) therapy over the motor cortex on pain, quality of life and thermal sensitivity in PMPS patients. METHODS We delivered 15 rTMS sessions over three weeks in a cohort of 34 PMPS patients. These patients were allocated randomly to either rTMS therapy or sham therapy groups. Pain assessments, utilizing the Visual Analogue Scale (VAS) and Short Form McGill Pain Questionnaire (SF-MPQ), alongside quality-of-life evaluations through the Functional Assessment of Cancer Therapy-Breast (FACT-B), were recorded before and after the 15 sessions. Additionally, we assessed thermal sensitivity using Quantitative Sensory Testing (QST). RESULTS Our findings demonstrate the superior efficacy of rTMS therapy (over sham therapy) in reducing VAS and SF-MPQ scores (p < 0.0001), improving physical (p = 0.037), emotional (p = 0.033), and functional well-being (p = 0.020) components of quality of life, as quantified by FACT-B. Our investigation also unveiled marked enhancements in thermal sensitivity within the rTMS therapy group, with statistically significant improvements in cold detection threshold (p = 0.0001), warm detection threshold (p = 0.0033), cold pain threshold (p = 0.0078), and hot pain tolerance threshold (p = 0.0078). CONCLUSION The study underscores the profound positive impact of rTMS therapy on pain, quality of life, and thermal sensitivity in patients having PMPS, opening new avenues for pain management strategies.
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Affiliation(s)
- Monika Kataria
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Nishkarsh Gupta
- Department of Onco-Anesthesiology and Palliative Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Aasheesh Kumar
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Sandeep Bhoriwal
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Akanksha Singh
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Varun Shekhar
- Department of Onco-Anesthesiology and Palliative Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Renu Bhatia
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
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Glavas Tahtler J, Djapic D, Neferanovic M, Miletic J, Milosevic M, Kralik K, Neskovic N, Tomas I, Mesaric D, Marjanovic K, Rajc J, Orkic Z, Cicvaric A, Kvolik S. Long-Term Outcomes of Breast Cancer Patients Receiving Levobupivacaine Wound Infiltration or Diclofenac for Postoperative Pain Relief. Pharmaceutics 2023; 15:2183. [PMID: 37765154 PMCID: PMC10534840 DOI: 10.3390/pharmaceutics15092183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Breast cancer is the most common malignant disease in women. Preclinical studies have confirmed that the local anesthetic levobupivacaine has a cytotoxic effect on breast cancer cells. We examined whether postoperative wound infiltration with levobupivacaine influences survival in 120 patients who were operated on for breast cancer and underwent quadrantectomy or mastectomy with axillary lymph node dissection. Groups with continuous levobupivacaine wound infiltration, bolus wound infiltration, and diclofenac analgesia were compared. Long-term outcomes examined were quality of life, shoulder disability, and hand grip strength (HGS) after one year and survival after 5 and 10 years. Groups that had infiltration analgesia had better shoulder function compared to diclofenac after one year. The levobupivacaine PCA group had the best-preserved HGS after 1 year (P = 0.022). The most significant predictor of the 5-year outcome was HGS (P = 0.03). Survival at 10 years was 85%, 92%, and 77% in the diclofenac, levobupivacaine bolus, and levobupivacaine PCA groups (ns. P = 0.36). The extent of the disease at the time of surgery is the most important predictor of long-term survival (P = 0.03). A larger prospective clinical study could better confirm the effect of levobupivacaine wound infiltration on outcomes after breast cancer surgery observed in this pilot study-trial number NCT05829707.
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Affiliation(s)
- Josipa Glavas Tahtler
- Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia; (J.G.T.); (A.C.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Dajana Djapic
- Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia; (J.G.T.); (A.C.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Marina Neferanovic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Jelena Miletic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Marta Milosevic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Kristina Kralik
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Nenad Neskovic
- Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia; (J.G.T.); (A.C.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Ilijan Tomas
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
- Department of Oncology and Radiotherapy, Osijek University Hospital, 31000 Osijek, Croatia
| | - Dora Mesaric
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
- Department of Oncology and Radiotherapy, Osijek University Hospital, 31000 Osijek, Croatia
| | - Ksenija Marjanovic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
- Department of Pathology and Forensic Medicine, Osijek University Hospital, 31000 Osijek, Croatia
| | - Jasmina Rajc
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
- Department of Pathology and Forensic Medicine, Osijek University Hospital, 31000 Osijek, Croatia
| | - Zelimir Orkic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
- Department of Surgery, Osijek University Hospital, 31000 Osijek, Croatia
| | - Ana Cicvaric
- Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia; (J.G.T.); (A.C.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Slavica Kvolik
- Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia; (J.G.T.); (A.C.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
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Incidence, risk factors, prevention and treatment of postmastectomy pain syndrome in breast cancer: A multicenter study. Int J Surg 2022; 106:106937. [PMID: 36152923 DOI: 10.1016/j.ijsu.2022.106937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Postmastectomy pain syndrome (PMPS) is a common postoperative condition after breast cancer surgery. PURPOSE The aim of this study was to investigate the incidence rate and risk factors of PMPS, and to propose prevention and treatment methods. METHODS The study included 1790 postoperative breast cancer patients from three hospitals from 2017 to 2021, of which 302 (13.0%) patients with PMPS were included in the study. RESULTS Age, breast surgery type, axillary surgery type and radiotherapy are the risk factors of PMPS. Age, radiotherapy and chemotherapy affect the pain degree of PMPS during movement. CONCLUSIONS For breast cancer patients with high risk factors, pain should be actively prevented during perioperative period. Oral pharmacological agents, multidisciplinary combination therapy, local anesthetics and regional anesthesia are the most common treatment of PMPS.
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Lin X, Cai Y, Chen X, Lin J, He Y, Xie L, Jiang X, Chen Y. Analgesia and stress attenuation of ultrasound-guided modified pectoral nerve block type-II with different volumes of 0.3% ropivacaine in patients undergoing modified radical mastectomy for breast cancer: A prospective parallel randomized double-blind controlled clinical trial. J Clin Pharm Ther 2022; 47:1676-1683. [PMID: 35765728 DOI: 10.1111/jcpt.13720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/23/2022] [Accepted: 05/29/2022] [Indexed: 12/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE A previous randomized clinical trial concluded that an optimal concentration of 0.3% ropivacaine could provide satisfactory analgesia for breast cancer patients undergoing modified radical mastectomy. We wondered if a smaller volume (30 ml vs. 40 ml) of 0.3% ropivacaine could still provide adequate analgesia in an ultrasound-guided PECS II block in modified radical mastectomy. METHODS We performed a prospective parallel randomized double-blind controlled clinical trial. Eligible patients were assigned to either the P30 or P40 group (30 or 40 ml of 0.3% ropivacaine, respectively). The skin area of hypoesthesia, anaesthetic plane determined with ultrasound, pain visual analogue scale (VAS), anaesthetic dosages, and complications were recorded. Serum levels of interleukin-1β and interleukin-6 were measured postoperatively. RESULTS AND DISCUSSION A total of 40 patients completed the trials, with 20 patients in each group. Although the skin area of hypoesthesia and the anaesthetic planes were significantly larger in the P40 group compared with the P30 group (p < 0.05), the VAS, analgesic and opioid doses, serum cytokine levels, anaesthetic toxicity, and complications had no significant differences between the two groups. WHAT IS NEW AND CONCLUSION Compared with 40 ml, 30 ml of 0.3% ropivacaine could provide adequate analgesia and reduce surgical stress in patients undergoing modified radical mastectomy for breast cancer.
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Affiliation(s)
- Xinqiang Lin
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian, Fujian, China.,Department of Anesthesiology, Putian Maternity and Child Care Hospital, Putian, Fujian, China
| | - Yuping Cai
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Xiao Chen
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Jianxin Lin
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Yingxi He
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Lijin Xie
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Xiaoling Jiang
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Yuren Chen
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian, Fujian, China
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Gupta R, Pushkarna G, Badhan C, Chawla S, Abbi P. Evaluation of the postoperative morphine-sparing effect of oral premedicants used as pre-emptive analgesics in breast-conserving cancer surgeries: A randomised placebo-controlled trial. Indian J Anaesth 2022; 66:S95-S101. [PMID: 35601043 PMCID: PMC9116636 DOI: 10.4103/ija.ija_361_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Aims: Breast cancer surgeries are associated with both nociceptive and neuropathic pain, requiring strong analgesics. We aimed to evaluate the postoperative morphine-sparing effect of pre-emptive oral premedication with tramadol versus pregabalin in patients undergoing breast-conserving cancer surgeries (BCCS). Methods: This prospective, randomised, placebo-controlled trial was carried out at tertiary care centre on 90 patients undergoing BCCS randomised into three groups of 30 each. Group C received placebo, Group T received tramadol 100 mg and Group P received pregabalin 75 mg as oral premedication, 1 hour before surgery. General anaesthesia was administered. Postoperatively morphine 1 mg.h-1 through intravenous PCA was started at a visual analogue scale score ≥4. Total morphine consumption in 24 hours was calculated and its sparing effect was evaluated as the primary outcome. Results: The median with interquartile range (IQR) of total postoperative morphine consumed in 24 hours, was found to be 22 mg (IQR 0-25.77), 15 mg (IQR 0-16) and 17.50 mg (IQR 0-19.25) in groups C, T, P respectively, (P = 0.000, 0.003, 0.060). The median duration of analgesia in group C was 5.40 hours (IQR 3.30-11.40), 11.6 hours (IQR 9.30-24.0) in group T and 8.60 hours (IQR 6.97-16.27) in group P (P value C/T = 0.000, C/P = 0.007, T/P = 0.002). The postoperative side effects were comparable. Conclusion: Oral tramadol 100 mg and oral pregabalin 75 mg as premedication reduced the 24 hours postoperative morphine requirement as compared to placebo in BCCS. However, tramadol 100 mg provided superior analgesia for longer duration than pregabalin 75 mg and was associated with more side effects.
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Long Q, Zhang J, Qi J, Fan Y, Li H. Analysis of factors influencing postoperative drainage time in breast cancer. Gland Surg 2021; 10:3272-3282. [PMID: 35070887 PMCID: PMC8749090 DOI: 10.21037/gs-21-697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2024]
Abstract
BACKGROUND To investigate the related factors affecting the postoperative indwelling time of drainage tubes (hereinafter referred to as drainage time) in breast cancer (BC) and evaluate the effect of Pseudomonas aeruginosa-mannose-sensitive hemagglutinin (PA-MSHA) preparation on reducing postoperative drainage time. METHODS The clinical data of 165 BC patients in our hospital, including the postoperative drainage time and occurrence of seroma and related complications (such as fever, incision infection, and flap necrosis) after extubation, were retrospectively analyzed. Univariate, multivariate, and stratified analyses were used to determine the correlations between 15 factors including age, body weight, body mass index (BMI), and PA-MSHA preparation, and the postoperative total drainage volume and drainage time. RESULTS Age, BMI, and PA-MSHA preparation were independent factors affecting the postoperative drainage volume and drainage time of BC patients. Age and BMI were positively correlated with postoperative drainage volume and drainage time (P≤0.004, P≤0.037). PA-MSHA preparation significantly reduced the postoperative total drainage volume and drainage time (P<0.001), decreased the incidence of seroma after extubation (P=0.024), and did not increase complications (P>0.05). CONCLUSIONS Obese and elderly patients were at a significantly high risk of a high drainage volume and long drainage time. Local treatment with PA-MSHA preparation had the advantages of reducing postoperative drainage volume, reducing drainage time, preventing seroma, and not increasing complications, and was a safe and effective treatment. For BC patients aged over 60 years and with a BMI ≥25, the intraoperative local spraying of wounds with PA-MSHA preparation to reduce postoperative drainage times is a valuable option.
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Affiliation(s)
- Quanyi Long
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jia Zhang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiahao Qi
- Linzi District Center for Disease Control and Prevention, Zibo, China
| | - Yuan Fan
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hongjiang Li
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
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