Postoperative Analgesia by Infusion of Local Anesthetic into the Surgical Wound after Modified Radical Mastectomy: A Randomized Clinical Trial

Autor: Laso, LF; Lopez-Picado, A; Lamata, L; Garcia, MC; Lopez, CI; Ruilope, LP; Hernandez, FL; Antoñanzas Villar, Fernando Jesús; Martinez, CV; Aizpuru, F; Chaves, RH; 

Tipo de documento: Artículo de revista

Revista: Plastic and Reconstructive Surgery. ISSN: 0032-1052. Año: 2014. Número: 6. Volumen: 134. Páginas: 862E-870E.

doi 10.1097/PRS.0000000000000762

JCR:
Edición:
Science  Área: SURGERY  Quartil: Q1  Lugar área: 36/198  F. impacto: 2,993 

SCIMAGO:
SJR:
1,875  SNIP: 1,816 

CIRC: GRUPO A - EXCELENCIA

Resumen: Background: There is no consensus on the efficacy of postoperative infusion of local anesthetics after radical mastectomy. Methods: A randomized, double-blind, placebo-controlled, parallel-groups clinical trial was conducted in a tertiary hospital. Eighty consecutive women with operable breast cancer with indications for modified radical mastectomy without breast reconstruction were assigned randomly to receive infusion of levobupivacaine (0.5%) or saline at 2 ml/hour for 48 hours through a wound catheter. Seventy-three women finished the study (intervention group, n = 34; control group, n = 39). During surgery, all patients received 0.25% levobupivacaine (30 ml). Results: The levobupivacaine group reported less pain (p < 0.001) than controls in the postanesthesia care unit (1.6 +/- 1.3 versus 6.7 +/- 1.8) and on the ward at 24 (0.8 +/- 0.9 versus 4.2 +/- 1.9) and 48 (0.4 +/- 0.7 versus 3.3 +/- 2.3) hours. In the postanesthesia care unit, the levobupivacaine group consumed less metamizole (0.4 +/- 0.5 versus 0.8 +/- 0.4; p < 0.001) and dexketoprofen (0.1 +/- 0.3 versus 0.7 +/- 0.4; p < 0.001), with differences in paracetamol use being insignificant (0.8 +/- 0.4 versus 0.9 +/- 0.3; p = 0.140). On the ward, the levobupivacaine group used significantly less paracetamol (0.5 +/- 0.7 versus 2.0 +/- 2.0; p < 0.001) and metamizole (0.2 +/- 0.4 versus 1.2 +/- 1.4; p < 0.001), but differences in dexketoprofen were not significant (0.03 +/- 0.2 versus 0.2 +/- 0.6; p = 0.074). In the postanesthesia care unit, the levobupivacaine and control groups consumed 0 +/- 0 and 0.7 +/- 1.2 doses of opioids (p = 0.001), respectively. The authors observed no differences in nausea and vomiting at any stage in the postanesthesia care unit (0.2 +/- 0.4 versus 0.4 +/- 0.5; p = 0.081) or on the ward (0.3 +/- 0.5 versus 0.4 +/- 0.5; p = 0.563). All participants reported high levels of satisfaction. Conclusion: Continuous infusion of local anesthetic reduces pain and analgesic consumption, with high satisfaction, but does not affect rates of nausea and vomiting.