Preemptive analgesia with bupivacaine for segmental mastectomy.

Full Abstract

BACKGROUND

AND OBJECTIVES:
Preemptive analgesia is the concept of providing analgesia before surgical incision, resulting in less postoperative pain. The purpose of this study is to determine if preemptive and/or postoperative local anesthetic infiltration of bupivacaine in patients undergoing segmental mastectomy results in less postoperative pain compared with patients receiving placebo.

METHODS:
In this prospective, double-blinded study, 120 patients were randomized into 4 groups:
group 1, preincisional (10 mL) and postoperative (10 mL) wound infiltration of 0.5% bupivicaine, (+Pre+Post); group 2, preincisional bupivacaine (10 mL) and postoperative infiltration (10 mL) of placebo (normal saline solution), (+Pre-Post); group 3, preincisional placebo (10 mL) and postoperative bupivacaine (10 mL), (-Pre+Post); or group 4, preincisional (10 mL) and postoperative infiltration of placebo (10 mL), (-Pre-Post). All patients received a standardized laryngeal mask general anesthetic. Data were recorded at the following time intervals:
preoperative admission, postanesthesia care unit (PACU) admission, PACU stay, stepdown-unit admission, stepdown-unit stay, hospital discharge, and 24 hours post operation.

RESULTS:
No difference was noted with respect to preoperative pain visual analog scale (VAS, 0-100 mm), surgical duration, PACU stay time, stepdown-unit stay time, incidence of postoperative nausea, or treatment for nausea in all measured time periods. The placebo group (group 4) had significantly higher mean pain VAS scores during the early postoperative period (PACU admission and PACU stay) compared to the other groups (PACU admission:
group 1 = 2 +/- 8, group 2 = 4 +/- 11, group 3 = 3 +/- 15, group 4 = 17 +/- 21, P < .01; PACU stay:
group 1 = 6 +/- 13, group 2 = 6 +/- 10, group 3 = 10 +/- 21, group 4 = 20 +/- 18, P < .01). Likewise, the number of patients who reported pain (pain frequency) was significantly higher in group 4 (placebo) compared with all other groups at PACU admission, PACU stay, stepdown-unit admission, and stepdown-unit stay (P < or = .01).

CONCLUSION:
Preincisional and/or postoperative wound bupivacaine infiltration lacks preemptive analgesic effects for segmental mastectomy.

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Author information

Author/s: Vallejo, Manuel C (MC); Phelps, Amy L (AL); Sah, Neera (N); Romeo, Ryan C (RC); Falk, Jeffrey S (JS); Johnson, Ronald R (RR); Keenan, Donald M (DM); Bonaventura, Margueritte A (MA); Edington, Howard D (HD);

Affiliation: Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA 15213, USA. vallejomc(-atsign-)anes.upmc.edu

Journal and publication information

Publication Type: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

Journal: Regional anesthesia and pain medicine (Reg Anesth Pain Med), published in United States. (Language: eng)

Reference: -2006 May-Jun; vol 31 (issue 3) : pp 227-32

Dates: Created 2006/05/16; Completed 2007/11/06;

PMID: 16701188, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Analgesics - administration & dosage
Anesthetics, Local - administration & dosage
Bupivacaine - administration & dosage
Double-Blind Method
Female
Humans
Mastectomy, Segmental

Mastectomy, Segmental
Middle Aged
Pain Measurement
Pain, Postoperative - prevention & control
Postoperative Care
Preanesthetic Medication
Prospective Studies

Associated Chemicals: Analgesics (0) ; Anesthetics, Local (0) ; Bupivacaine (2180-92-9)

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