Chronic pain and sensory changes after augmentation mammoplasty: long term effects of preincisional administration of methylprednisolone.
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.
Romundstad
Luis
L
University of Oslo, Department Group of Clinical Medicine, Rikshospitalet University Hospital, Oslo, Norway. luisro@medisin.uio.no
Breivik
Harald
H
Roald
Helge
H
Skolleborg
Knut
K
Romundstad
Pål Richard
PR
Stubhaug
Audun
A
D000328:Adult; D000704:Analysis of Variance; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D004056:Differential Threshold / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use; D016462:Mammaplasty / Q000009:adverse effects*; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology*; D011446:Prospective Studies; D013995:Time; D013997:Time Factors; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D016861:Cyclooxygenase Inhibitors; D007555:Isoxazoles; C409945:parecoxib; D008775:Methylprednisolone