title: Perioperative lidocaine infusion reduces the incidence of post-mastectomy chronic pain: a double-blind, placebo-controlled randomized trial.
abstract: BACKGROUND
  Chronic post-surgical pain (CPSP) is a not uncommon complication after mastectomy, with a reported incidence between 20% and 68%. Careful dissection, the use of minimally invasive surgical techniques, and attempts to reduce the associated inflammatory and hyperalgesic responses are suggested methods to prevent CPSP.
  
  
  OBJECTIVE
  To determine if the use of perioperative lidocaine infusion is associated with decreased incidence of CPSP after mastectomy.
  
  
  METHODS
  Double-blind, placebo-controlled randomized trial.
  
  
  METHODS
  This is a secondary analysis of data from 61 out of 71 patients who underwent mastectomy for breast cancer. Patients were randomized to either placebo (Group P; n = 27) or intravenous lidocaine (Group L; n = 34, bolus 1.5 mg/kg at induction, then infusion at 2 mg/kg/hr, up to 2 hours after the end of surgery) in a prospective double-blind design. CPSP was assessed at 6 months after surgery. Stepwise logistic regression analysis was performed to assess the efficacy of lidocaine.
  
  
  RESULTS
  Overall 12 (20%) patients developed CPSP, 8 (30%) in the placebo group and 4 (12%) in the lidocaine group. Predictive factors for CPSP that remained significant after multivariate analysis included lidocaine (associated with a 20-fold decrease in CPSP, P = 0.013), breast implant placement (associated with a 16-fold increase in CPSP, P = 0.034), and radiotherapy (associated with a 29-fold increase in CPSP, P = 0.008).
  
  
  CONCLUSIONS
  Small sample size.
  
  
  CONCLUSIONS
  Perioperative lidocaine administration was associated with a decreased incidence of CPSP, while breast implant placement and radiotherapy were associated with an increased incidence. These findings suggest a protective effect of lidocaine on CPSP development in mastectomy patients.
authors: Abdullah S
authors: AS
authors: Terkawi
authors: Sonal
authors: S
authors: Sharma
authors: Marcel E
authors: ME
authors: Durieux
authors: Swapna
authors: S
authors: Thammishetti
authors: David
authors: D
authors: Brenin
authors: Department of Anesthesiology, University of Virginia, Charlottesville, VA Department of Anesthesiology, Women and Children's Hospital of Buffalo; Department of Surgery, University of Virginia, Charlottesville, VA.
authors: Mohamed
authors: M
authors: Tiouririne
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000601:surgery; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D008012:Lidocaine / Q000008:administration & dosage*; D008408:Mastectomy / Q000009:adverse effects* / Q000639:trends; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D019990:Perioperative Care / Q000379:methods*; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine