title: Does a continuous local anaesthetic pain treatment after immediate tissue expander reconstruction in breast carcinoma patients more efficiently reduce acute postoperative pain--a prospective randomised study.
abstract: BACKGROUND
  Immediate breast reconstruction with an expander is a reasonable option for properly selected patients. After reconstruction, patients have severe postoperative pain, which responds poorly to opioids. Our aim was to evaluate if continuous wound infusion of a local anaesthetic into the surgical wound reduces postoperative pain, consumption of opioids and incidence of chronic pain compared to standard intravenous piritramide after primary breast reconstruction in breast carcinoma patients.
  
  
  METHODS
  Altogether, 60 patients were enrolled in our study; one half in the group with wound infusion of a local anaesthetic, and the other half in the standard (piritramide) group. Parameters measured included: pain intensity (visual analogue scale), drug requirements, alertness, hospitalisation, side-effects and late complications. A p-value of < 0.05 was considered statistically significant.
  
  
  RESULTS
  In the recovery room, the test group reported less acute pain at rest (P = 0.03) and at activity (P = 0.01), and on the day of the surgical procedure they reported less pain at activity (P = 0.003). Consumption of piritramide and metoclopramide was lower in this group (P < 0.0001), but their alertness after the surgical procedure was higher compared to the standard group (P < 0.001). After three months, the test group reported less chronic pain (P = 0.01).
  
  
  CONCLUSIONS
  After primary tissue expander breast reconstruction, wound infusion of a local anaesthetic significantly reduces acute pain and enables reduced opioid consumption, resulting in less postoperative sedation and reduced need for antiemetic drugs. Wound infusion of a local anaesthetic reduces chronic pain.
authors.affiliation: Department of Anaesthesiology, Institute of Oncology, Zaloska 2, Ljubljana SI-1000, Slovenia. bstrazisar@onko-i.si.
authors.forename: Branka
authors.initials: B
authors.lastname: Strazisar
authors.forename: Nikola
authors.initials: N
authors.lastname: Besic
authors.forename: Uros
authors.initials: U
authors.lastname: Ahcan
mesh_terms: D000208:Acute Disease; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000150:complications / Q000556:secondary / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000150:complications / Q000556:secondary / Q000601:surgery; D018275:Carcinoma, Lobular / Q000150:complications / Q000556:secondary / Q000601:surgery; D016022:Case-Control Studies; D002408:Catheters, Indwelling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D016462:Mammaplasty / Q000009:adverse effects*; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D011183:Postoperative Complications / Q000517:prevention & control*; D011379:Prognosis; D011446:Prospective Studies; D015625:Tissue Expansion Devices / Q000009:adverse effects*
chemical_list: D000779:Anesthetics, Local