Chronic pain and sensory changes after augmentation... : PAIN (original) (raw)
Articles
Chronic pain and sensory changes after augmentation mammoplasty: Long term effects of preincisional administration of methylprednisolone
Romundstad, Luisa,*; Breivik, Haralda; Roald, Helgeb; Skolleborg, Knutb; Romundstad, Pål Richardc; Stubhaug, Auduna
a_University of Oslo, Department Group of Clinical Medicine, Department of Anaesthesiology, Rikshospitalet University Hospital, Oslo, Norway_
b_Department of Plastic Surgery, Colosseum Clinic, Oslo, Norway_
c_Norwegian University of Science and Technology, Department of Public Health and General Practice, Trondheim, Norway_
*Corresponding author. Tel.: +47 23073700; fax: +47 23073690.
E-mail address:[email protected]
Received July 4, 2005; received in revised form February 26, 2006; accepted March 27, 2006.
Abstract
We studied the prevalence of chronic pain and long term sensory changes after cosmetic augmentation mammoplasty and the effects of a single i.v. preoperative dose of methylprednisolone 125 mg (n = 74), parecoxib 40 mg (n = 71), or placebo (n = 74). A questionnaire was mailed 6 weeks and 1 year after surgery. Response rate after 1 year was 80%. At 1 year non-evoked pain was present in 13%, and evoked pain was present in 20% with no statistically significant differences between the groups. Methylprednisolone was associated with reduced odds for hyperesthesia at 1 year (OR 0.3, 95% CI 0.1–0.6), and significantly reduced the prevalence of hyperesthesia (30%) compared with placebo (56%, P < 0.01) and parecoxib (51%, P < 0.04). Factors associated with increased odds for pain at 1 year were intensity of pain during the first 6 days after surgery (OR 1.3, 95% CI 1.1–1.6), pain at 6 weeks (OR 18.4, 95% CI 6.9–49.3), hyperesthesia at 6 weeks (OR 2.3, 95% CI 1.1–5.1) and present hyperesthesia (OR 3.1, 95% CI 1.4–6.7). We conclude that persistent pain and sensory changes are common after augmentation mammoplasty, and that patients having pain at 6 weeks most likely will have pain also at 1 year. Acute postoperative pain, hyperesthesia at 6 weeks, and the presence of hyperesthesia increased the odds for pain at 1 year. Preoperative methylprednisolone resulted in significantly less hyperesthesia compared with both parecoxib and placebo, but did not significantly reduce the prevalence of persistent spontaneous or evoked pain.
© 2006 Lippincott Williams & Wilkins, Inc.