title: Multimodal analgesia with gabapentin and local anesthetics prevents acute and chronic pain after breast surgery for cancer.
abstract: We evaluated the effect of multimodal analgesia on acute and chronic pain after breast surgery for cancer. Fifty patients scheduled for breast cancer surgery were blindly randomized to receive gabapentin, eutectic mixture of local anesthetics cream, and ropivacaine in the wound or three placebos. Pain (visual analog scale) and analgesics were recorded in the postanesthesia care unit (PACU) 3, 6, and 9 h and 8 days after surgery. Three and 6 mo later, patients were assessed for chronic pain. The treatment group consumed less paracetamol in the PACU (469 versus 991 mg; P < 0.002) and less Lonalgal (1.0 versus 4.4 tablets; P = 0.003) than the controls, exhibited lower visual analog scale scores at rest in the PACU (P = 0.001) and on postoperative Days 1, 3, and 5 (P = 0.040, P = 0.015, and P = 0.045, respectively), and after movement in the PACU (P = 0.001) and on postoperative Days 2, 4, and 8 (P = 0.028, P = 0.007, and P = 0.032, respectively). Three and 6 mo after surgery, 18 of 22 (82%) and 12 of 21 (57%) of the controls reported chronic pain versus 10 of 22 (45%) and 6 of 20 (30%) in the treatment group (P = 0.028 and P = 0.424, respectively); 5 of 22 and 4 of 21 of the controls required analgesics versus 0 of 22 and 0 of 20 of those treated (P = 0.048 and P = 0.107, respectively). Multimodal analgesia reduced acute and chronic pain after breast surgery for cancer.
authors.affiliation: *Department of Anesthesiology, Aretaieion Hospital, Medical School, University of Athens; †Department of Anesthesiology, St. Savas Hospital, Athens, Greece; and ‡Department of Anesthesiology, Medical College of Wisconsin, Milwaukee.
authors.forename: Argyro
authors.initials: A
authors.lastname: Fassoulaki
authors.forename: Argyro
authors.initials: A
authors.lastname: Triga
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Melemeni
authors.forename: Constantine
authors.initials: C
authors.lastname: Sarantopoulos
mesh_terms: D000208:Acute Disease; D000328:Adult; D000588:Amines / Q000009:adverse effects / Q000627:therapeutic use*; D000698:Analgesia; D000779:Anesthetics, Local / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000601:surgery*; D002908:Chronic Disease; D003509:Cyclohexanecarboxylic Acids / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D005680:gamma-Aminobutyric Acid / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000588:Amines; D000779:Anesthetics, Local; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin