Efficacy of infiltration of local anaesthetic for pain relief after total mastectomy


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Samy Shaheed1, Charles Zammit1
1Breast Unit, Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, United Kingdom

Background

It is our practice to infiltrate local anaesthetic after mastectomy to reduce post operative pain and the unwanted side effect from narcotics. However, it is still believed that most of the infiltrate is wasted into the cavity and the drain with no significant effect. We designed this study to determine the efficacy of local anaesthetic after mastectomy.

Method

A double blind randomised prospective trial, with 72 patients allocated into two groups. All patients had total mastectomy with axillary  node procedure under standardised anaesthesia. In the first group (treatment group) 39 patients received 30mls of 0.5% bupivacaine, partly injected into the flaps and partly into the cavity with drain closed for 20 min to allow absorption. In the second group (Control group) 33 patients did not receive local anaesthetic. Patient Controlled Analgesia (PCA) was set for all patients. Post operative pain was evaluated by Verbal Analogue Scale (VAS 1-10), at rest and movement, as well as satisfaction with pain control using 5 point scale. PCA total consumption and dose demand ratio were recorded.

Results

Although fewer patients in the treatment group showed high VAS scores than controls, the median scores remained very similar being 1.8 for both groups at rest, 1.9 and 2.1 (for treatment and control groups respectively) with movement. Pain control satisfaction showed a median of 4.5 (treatment group) and 4.2 (control group). On the other hand total PCA consumption showed higher median for the treatment group than control (8.1 and 7.6 mg) with higher number of demands.

Conclusion

Although treatment group showed better VAS sores and pain control satisfaction, this is not significant and not  consistent with the total PCA consumption. This study does not show a significant benefit from infiltration of the local anaesthesia in mastectomy patients, and simple oral analgesics may suffice for pain control.