title: Postoperative analgesia by infusion of local anesthetic into the surgical wound after modified radical mastectomy: a randomized clinical trial.
abstract: BACKGROUND
  There is no consensus on the efficacy of postoperative infusion of local anesthetics after radical mastectomy.
  
  
  METHODS
  A randomized, double-blind, placebo-controlled, parallel-groups clinical trial was conducted in a tertiary hospital. Eighty consecutive women with operable breast cancer with indications for modified radical mastectomy without breast reconstruction were assigned randomly to receive infusion of levobupivacaine (0.5%) or saline at 2 ml/hour for 48 hours through a wound catheter. Seventy-three women finished the study (intervention group, n = 34; control group, n = 39). During surgery, all patients received 0.25% levobupivacaine (30 ml).
  
  
  RESULTS
  The levobupivacaine group reported less pain (p < 0.001) than controls in the postanesthesia care unit (1.6 ± 1.3 versus 6.7 ± 1.8) and on the ward at 24 (0.8 ± 0.9 versus 4.2 ± 1.9) and 48 (0.4 ± 0.7 versus 3.3 ± 2.3) hours. In the postanesthesia care unit, the levobupivacaine group consumed less metamizole (0.4 ± 0.5 versus 0.8 ± 0.4; p < 0.001) and dexketoprofen (0.1 ± 0.3 versus 0.7 ± 0.4; p < 0.001), with differences in paracetamol use being insignificant (0.8 ± 0.4 versus 0.9 ± 0.3; p = 0.140). On the ward, the levobupivacaine group used significantly less paracetamol (0.5 ± 0.7 versus 2.0 ± 2.0; p < 0.001) and metamizole (0.2 ± 0.4 versus 1.2 ± 1.4; p < 0.001), but differences in dexketoprofen were not significant (0.03 ± 0.2 versus 0.2 ± 0.6; p = 0.074). In the postanesthesia care unit, the levobupivacaine and control groups consumed 0 ± 0 and 0.7 ± 1.2 doses of opioids (p = 0.001), respectively. The authors observed no differences in nausea and vomiting at any stage in the postanesthesia care unit (0.2 ± 0.4 versus 0.4 ± 0.5; p = 0.081) or on the ward (0.3 ± 0.5 versus 0.4 ± 0.5; p = 0.563). All participants reported high levels of satisfaction.
  
  
  CONCLUSIONS
  Continuous infusion of local anesthetic reduces pain and analgesic consumption, with high satisfaction, but does not affect rates of nausea and vomiting.
authors.affiliation: Vitoria-Gasteiz, Zaragoza, and Logroño, Spain From the Department of Anesthesiology and Postoperative Care, Araba Research Unit, and Department of Pharmacy, Araba University Hospital; the Department of Surgery, Zaragoza University Hospital; and the Department of Economics and Business, University La Rioja.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Ferreira Laso
authors.forename: Amanda
authors.initials: A
authors.lastname: Lopez-Picado
authors.forename: Laura
authors.initials: L
authors.lastname: Lamata
authors.forename: Mar
authors.initials: M
authors.lastname: Ceballos Garcia
authors.forename: Carolina
authors.initials: C
authors.lastname: Ibañez López
authors.forename: Lorena
authors.initials: L
authors.lastname: Pipaon Ruilope
authors.forename: Felix
authors.initials: F
authors.lastname: Lamata Hernandez
authors.forename: Fernando
authors.initials: F
authors.lastname: Antoñanzas Villar
authors.forename: Cesar
authors.initials: C
authors.lastname: Valero Martinez
authors.forename: Felipe
authors.initials: F
authors.lastname: Aizpuru
authors.forename: Roberto
authors.initials: R
authors.lastname: Hernanz Chaves
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D036502:Infusions, Intralesional; D000077554:Levobupivacaine; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine