Assessment of post-operative analgesia in modified radical mastectomy patients using surgical wound irrigation with 0.25% bupivacaine (original) (raw)
Related papers
Indian journal of anaesthesia, 2015
Modified Radical Mastectomy (MRM) is the commonly used surgical procedure for operable breast cancer, which involves extensive tissue dissection. Therefore, wound instillation with local anaesthetic may provide better postoperative analgesia than infiltration along the line of incision. We hypothesised that instillation of bupivacaine through chest and axillary drains into the wound may provide postoperative analgesia. In this prospective randomised controlled study 60 patients aged 45-60 years were divided into three groups. All patients were administered general anaesthesia. At the end of the surgical procedure, axillary and chest wall drains were placed before closure. Group C was the control with no instillation; Group S received 40 ml normal saline, 20 ml through each drain; and Group B received 40 ml of 0.25% bupivacaine and the drains were clamped for 10 min. After extubation, pain score for both static and dynamic pain was evaluated using visual analog scale and then 4(th) h...
2019
Original Research Article To study the efficacy of instillation of bupivacaine into the surgical drain for post-operative pain relief in modified radical mastectomy, after obtaining institutional ethical committee clearance and written informed consent from the patient for this randomized prospective controlled double blinded study, 50 female patients with carcinoma breast of ASA I & II between the age group of 35 -65 years posted for modified radical mastectomy were divided into two groups, Group (C) and Group(S). All patients were selected according to the inclusion and exclusion criteria. Postoperative ward nurse monitors and records the data. The investigator collected the data only. GROUP (S)-Receives 0.25% Bupivacaine 30 ml through the surgical drain after skin closure. GROUP (C)-Receives Normal saline 30 ml through the surgical drain. Preoperatively, all patients were educated about the reading of pain score with ten pointed visual analogue scale. General anesthesia was given...
Indian Journal of Clinical Anaesthesia
Modified Radical Mastectomy (MRM) is the commonly used surgical procedure for operable breast cancer, which involves extensive tissue dissection.We hypothesized that instillation of 0.25% bupivacaine and 0.2% ropivacaine through chest and axillary drains into the wound may provide postoperative analgesia, even better than infiltration along the line of incision. In this prospective randomized controlled study 68 patients aged more than 18 years were divided into four groups. All patients were administered general anesthesia. At the end of the procedure, axillary and chest drains were placed before closure. Group C was the control group with no instillation, group B received 40 ml 0.25% bupivacaine, group R received 40 ml 0.2% ropivacaine and group S received 40 ml normal saline (20ml through each drain) and the drains were clamped for 10 mins. After extubation, pain score was evaluated using Visual Analogue Scale (VAS) at rest, cough and overhead abduction of the arm at 0,1,2,3,4,8,...
Cureus
Background: In contrast to other breast surgeries, modified radical mastectomy (MRM) with axillary lymph node clearance involves intense tissue dissection, with postoperative seroma formation and pain being the major complaints affecting patients. Among these, 40% of females experience acute postoperative pain, and between 25 to 60% develop persistent chronic postsurgical pain. The rationale of this study was that minimally invasive procedures can result in immediate pain relief in patients undergoing mastectomy, which has been proven to satisfy their needs and lead to early discharge in the local population. Objective: This study determined to find out the efficacy of instilling bupivacaine on wounds by means of surgical drains in controlling pain after MRM. Methodology: This was a randomized control study trial that was carried out in Surgical Unit 1, Ward 3, Jinnah Postgraduate Medical Centre, Karachi, from November 2020 to April 2021. All patients tested negative for coronavirus disease 2019 (COVID-19) by PCR test before randomly allocating them into two groups. Thirty women in Group B received 40 ml of 0.25% injection bupivacaine, and 30 in Group C received no drug. Duration of analgesia was recorded as time in hours when the patient was received after surgery in the post-anesthesia care unit until the patient felt ache and discomfort of > three scores according to the visual analog pain score chart (VAS). Results: The average age was 52.48±4.76 years. The mean period of time during which analgesia was observed was significantly higher in Group B as compared to Group C (10.93±1.84 vs 5.03±1.35 hours, p=0.0005). Conclusion: There is improvement in postoperative analgesia after instilling bupivacaine through surgical drains on wound beds in MRM patients.
Preemptive Analgesia With Bupivacaine for Segmental Mastectomy
Regional Anesthesia and Pain Medicine, 2006
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, (ϩPreϩPost); group 2, preincisional bupivacaine (10 mL) and postoperative infiltration (10 mL) of placebo (normal saline solution), (ϩPreϪPost); group 3, preincisional placebo (10 mL) and postoperative bupivacaine (10 mL), (ϪPreϩPost); or group 4, preincisional (10 mL) and postoperative infiltration of placebo (10 mL), (ϪPreϪPost). 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 ϭ 2 Ϯ 8, group 2 ϭ 4 Ϯ 11, group 3 ϭ 3 Ϯ 15, group 4 ϭ 17 Ϯ 21, P Ͻ .01; PACU stay: group 1 ϭ 6 Ϯ 13, group 2 ϭ 6 Ϯ 10, group 3 ϭ 10 Ϯ 21, group 4 ϭ 20 Ϯ 18, P Ͻ .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 Յ .01). Conclusion: Preincisional and/or postoperative wound bupivacaine infiltration lacks preemptive analgesic effects for segmental mastectomy.
Medicina Universitaria, 2014
Objective: Determining the effectiveness of iniltration versus instillation with 7.5% ropivacaine in reducing the intensity of postoperative pain in patients undergoing a radical mastectomy. Material and methods: Clinical, prospective, and comparative analytical study in a sample of 20 female patients between 20 and 60 years of age, ASA I and II, weight 50-90 kg, who were divided into 2 groups (10 patients each). In Group 1 infiltration with ropivacaine 7.5% (20 ml) was applied prior to closure of the surgical wound, meanwhile in Group 2 ropivacaine 7.5% (20 ml), was instilled into the surgical wound. Pain intensity was assessed by a visual analog scale (VAS) upon extubation. The need for rescue medication and the incidence of nausea and vomiting were measured from 0 to 30 minutes postoperatively and at 2, 4, 8 and 12 hours. Results: There was no statistical difference between the groups (only the group managed through iniltration required rescue medications), but the iniltration group had a lower perception of pain. Conclusions: This study reported the same eficacy of preventive treatment of postoperative pain in patients who underwent radical mastectomy for instillation and iniltration with 7.5% ropivacaine and little need for rescue medication postoperatively.
Journal of Pain Research, 2020
Background: Serratus anterior plane (SAP) block, a novel regional anesthetic procedure, involves the anterolateral chest wall. Opioid receptors have been found on peripheral nerve terminals, so morphine may have a local action. Objective: This work aimed at exploring the analgesic efficacy of morphine added to bupivacaine in SAPB in patients for whom modified radical mastectomy was conducted and whether it is a mere local effect. Methods: Forty female patients were planned to have modified radical mastectomy participated in the study. Patients were randomly divided into two groups; Control group (C): received ultrasound-guided serratus anterior plane block with 20 mL of bupivacaine hydrochloride 0.25%; Morphine group (M): received the same in addition to 10 mg morphine sulfate. Intra-and postoperative blood samples were taken for the assessment of morphine serum levels. All patients were assessed for VAS scores during rest and movement (VAS-R and VAS-M). Time to the first request and the total amount of the rescue analgesia were recorded. Results: In group M, Morphine was not detected in the plasma of all patients. Both VAS-R and VAS-M were significantly higher in group C than in group M (P<0.001) and (P≤0.003), respectively. Time to the first request of rescue analgesia was 8.5 h in group C compared to 20 h in group M (P=0.005) with a median dose of acetaminophen consumption of 2 g in group C compared to 1 g in group M (P=0.006). Conclusion: Ten mg of morphine, when added to bupivacaine in SAPB, improved postoperative analgesia in patients to whom modified radical mastectomy was conducted. This effect seems to be attributed merely to local mechanisms. Registration: The registration number of this study is NCT02962024 at www.clinicaltrial. gov.
Journal of Pain Research, 2020
BackgroundSerratus anterior plane (SAP) block, a novel regional anesthetic procedure, involves the anterolateral chest wall. Opioid receptors have been found on peripheral nerve terminals, so morphine may have a local action.ObjectiveThis work aimed at exploring the analgesic efficacy of morphine added to bupivacaine in SAPB in patients for whom modified radical mastectomy was conducted and whether it is a mere local effect.MethodsForty female patients were planned to have modified radical mastectomy participated in the study. Patients were randomly divided into two groups; Control group (C): received ultrasound-guided serratus anterior plane block with 20 mL of bupivacaine hydrochloride 0.25%; Morphine group (M): received the same in addition to 10 mg morphine sulfate. Intra- and post-operative blood samples were taken for the assessment of morphine serum levels. All patients were assessed for VAS scores during rest and movement (VAS-R and VAS-M). Time to the first request and the total amount of the rescue analgesia were recorded.ResultsIn group M, Morphine was not detected in the plasma of all patients. Both VAS-R and VAS-M were significantly higher in group C than in group M (P<0.001) and (P≤0.003), respectively. Time to the first request of rescue analgesia was 8.5 h in group C compared to 20 h in group M (P=0.005) with a median dose of acetaminophen consumption of 2 g in group C compared to 1 g in group M (P=0.006).ConclusionTen mg of morphine, when added to bupivacaine in SAPB, improved postoperative analgesia in patients to whom modified radical mastectomy was conducted. This effect seems to be attributed merely to local mechanisms.RegistrationThe registration number of this study is {"type":"clinical-trial","attrs":{"text":"NCT02962024","term_id":"NCT02962024"}}NCT02962024 at www.clinicaltrial.gov.
Pakistan Journal of Medical and Health Sciences, 2021
Background: Severe postsurgical pain continues to be hard to manage in patients who experience breast cancer surgery. Badly managed pain can lead to meager patient satisfaction, prolonged hospital stay, and increased risk of complication by analgesics, and may be a reason in the development of long-lasting pain. Aim: To compare the efficacy of Intravenous Tramadol and Bupivacaine irrigation through surgical drains after Modified Radical Mastectomy in patients with carcinoma breast. Methods: This was a randomized controlled trial conducted in the Department of Anesthesia, Mayo Hospital Lahore. Total 70 female patients aged 18-70 years undergoing radical mastectomy for CA breast diagnosed on histopathology were selected. Patients were divided into two groups A and B through simple random sampling technique. Group A received intravenous Tramadol. Group B received Bupivacaine through surgical drains. Results: At 0, 2, 4 and 6 hour postoperatively no significant difference was seen in se...