Acute and persistent postoperative pain after breast surgery.
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.
Fecho
Karamarie
K
Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7010, USA. kfecho@aims.unc.edu
Miller
Natalie R
NR
Merritt
Sarah A
SA
Klauber-Demore
Nancy
N
Hultman
C Scott
CS
Blau
William S
WS
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
D000701:Analgesics, Opioid