Pain relief following breast augmentation surgery: a comparison between incisional patient-controlled regional analgesia and traditional oral analgesia.
OBJECTIVE
Postoperative pain is a common problem following ambulatory breast augmentation surgery. This study was performed to compare standard of care (oral analgesics) with patient-controlled incisional regional analgesia (PCRA) for postoperative pain management at home for 48 h. A second aim was to compare the analgesic efficacy of ropivacaine 0.25% vs. 0.5%.


METHODS
Surgery was performed under local anaesthesia and monitored anesthesia care. Sixty adults (ASA 1-2) were randomized to one of two groups. Patients in Group PCRA could self-administer ropivacaine 0.25% 10 mL in the left breast and ropivacaine 0.5% in the right breast. Patients in Group T (tablets) received our standard of care treatment, i.e. oral paracetamol 1 g four times a day and oral ibuprofen 500 mg three times a day. Parameters measured included: analgesic requirements (in post-anesthesia care unit, PACU and post-discharge), pain intensity (visual analogue scale), patient satisfaction, global analgesia, side-effects, and quality of recovery.


RESULTS
Pain scores were significantly lower in Group PCRA compared to Group T at all time periods (P < 0.05). No differences were found in pain scores between the right and left breasts. Significantly more patients in Group T requested analgesics in the recovery unit (27 vs. 7; P = 0.001) and also at home (20 vs. 11; P < 0.02). More patients in the tablet group had nausea and vomiting (10 vs. 3; P < 0.05). Global analgesia on day 2 was significantly better in PCRA group; however, patient satisfaction was similar in both groups. More patients in the tablet group had sleep disturbance and woke up at night due to pain.


CONCLUSIONS
Pain relief after ambulatory breast augmentation is superior with incisional PCRA when compared to oral analgesic combination of paracetamol and ibuprofen. Incisional PCRA was associated with minimal side-effects and less sleep disturbance. There was no difference in the analgesic efficacy between ropivacaine 0.25% and 0.5%.
Rawal
N
N
University Hospital, Department of Anesthesiology and Intensive Care, Orebro, Sweden. n.rawal@orebroll.se
Gupta
A
A
Helsing
M
M
Grell
K
K
Allvin
R
R
D000284:Administration, Oral; D000328:Adult; D000556:Ambulatory Surgical Procedures; D000577:Amides / Q000008:administration & dosage; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000777:Anesthetics / Q000008:administration & dosage*; D001940:Breast / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D000077212:Ropivacaine; D013997:Time Factors
D000577:Amides; D000777:Anesthetics; D000077212:Ropivacaine