Patient outcomes after axillary lymph node dissection for breast cancer: use of postoperative continuous local anesthesia infusion.
BACKGROUND
Although considered a safe surgical procedure, axillary lymph node dissection (ALND) is associated with postoperative numbness, paresthesias, pain, and muscle weakness. Despite meticulous surgical technique and the absence of long thoracic or thoracodorsal nerve injury, the risk of these complications are reported as great as 35% to 50%, with a subset of patients developing chronic pain syndromes.


METHODS
Female patients (n = 27) undergoing Level I-II ALND for breast cancer were recruited. After ALND, patients were randomized to three groups. Group 1 received standard axillary lymph node dissection. Patients assigned to group 2 or 3 (double-blinded) received 120 h continuous 0.9% saline solution or 0.5% bupivacaine using a catheter placed into the axilla and delivered by an elastomeric pump device. After routine postoperative care, patients were discharged with oral opioid analgesics. Twice-daily assessment of pain, sedation, and nausea were conducted using validated visual-analog scale measures. Daily and total opioid analgesic requirements after surgery were recorded.


RESULTS
Patients treated with a continuous infusion of bupivacaine experienced significantly lower pain scores (P < 0.001) during the first 5 postoperative days. Postoperative opioid analgesic requirements also were significantly decreased in the bupivacaine group, and these effects persisted until postoperative day 14 (P < 0.001). Concomitant to the observed decreases in pain and oral opioid requirements, nausea and morning sedation also were significantly reduced. There were no pump-related complications, wound infections, or postoperative axillary fluid collections.


CONCLUSIONS
The use of continuous administration of bupivicaine after ALND significantly decreases pain and opioid analgesic requirements, with concomitant decreases in nausea and sedation. This study provides encouraging evidence of the therapeutic benefits of continuous infusion of local anesthesia and may represent a valuable adjunct for surgical patients who require ALND, including those with breast cancer and melanoma.
Cancer Institute of New Jersey, Surgical Oncology, Robert Wood Johnson Medical School/UMDNJ, New Brunswick, New Jersey 08903, USA.
Scott R
SR
Schell
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001365:Axilla; D001943:Breast Neoplasms / Q000601:surgery*; D002045:Bupivacaine / Q000008:administration & dosage*; D016292:Procedural Sedation; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D010865:Pilot Projects; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002045:Bupivacaine