title: Acute and persistent postoperative pain after breast surgery.
abstract: OBJECTIVE
  This study's primary aim was to determine levels of acute and persistent postoperative pain and the incidence of severe postoperative pain after mastectomy. A secondary aim was to examine factors associated with postoperative pain.
  
  
  METHODS
  A retrospective cohort study of 196 female breast surgery subjects was conducted. Data were collected on: numerical rating scale (NRS) pain scores in the Post Anesthesia Care Unit (PACU) and at 1 month and 6-12 months postoperative; age; race; insurance; obesity; radiotherapy; chemotherapy; hypertension; anesthesia care time; and intraoperative and PACU opioid use. Severe postoperative pain was defined as NAS > or = 5. Data were analyzed using chi square, Fisher's exact test or analysis of variance, with alpha = 0.05.
  
  
  RESULTS
  PACU pain and the incidence of severe PACU pain increased with surgical complexity (P < 0.005). PACU pain scores averaged 4.71 +/- 0.24 and 57.7% of subjects experienced severe pain. Postoperative pain scores at 1 or 6-12 months did not vary by surgical complexity and averaged 2.21 +/- 0.32 and 0.74 +/- 0.22, respectively. Severe postoperative pain was experienced by 22.1% of subjects at 1 month and 8.2% of subjects at 6-12 months. Older age and systolic hypertension were associated with less PACU pain. Non-White race, obesity, and high PACU opioid use were associated with greater postoperative pain at 1 month. Non-White people also had greater postoperative pain at 6-12 months.
  
  
  CONCLUSIONS
  The results suggest that nearly 60% of breast surgery patients experience severe acute postoperative pain, with severe pain persisting for 6-12 months in almost 10% of patients.
authors.affiliation: Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7010, USA. kfecho@aims.unc.edu
authors.forename: Karamarie
authors.initials: K
authors.lastname: Fecho
authors.forename: Natalie R
authors.initials: NR
authors.lastname: Miller
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Merritt
authors.forename: Nancy
authors.initials: N
authors.lastname: Klauber-Demore
authors.forename: C Scott
authors.initials: CS
authors.lastname: Hultman
authors.forename: William S
authors.initials: WS
authors.lastname: Blau
mesh_terms: D000208:Acute Disease / Q000453:epidemiology; D017677:Age Distribution; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001940:Breast / Q000503:physiopathology / Q000601:surgery*; D001941:Breast Diseases / Q000601:surgery*; D002908:Chronic Disease / Q000453:epidemiology; D015331:Cohort Studies; D004358:Drug Therapy / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008408:Mastectomy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology; D010149:Postoperative Pain / Q000453:epidemiology*; D044469:Racial Groups; D011878:Radiotherapy / Q000009:adverse effects / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid