title: Does the perioperative analgesic/anesthetic regimen influence the prevalence of long-term chronic pain after mastectomy?
abstract: OBJECTIVE
  To investigate if the anesthetic/analgesic regimen is associated with the risk of reporting long-term chronic postmastectomy pain (CPMP).
  
  
  METHODS
  Cross-sectional survey
  
  
  METHODS
  Academic hospital
  
  
  METHODS
  A total of 267 women having undergone mastectomy with axillary lymph node dissection between 2003 and 2008 INTERVENTIONS: All patients were contacted between October and December 2012, with a questionnaire asking for persistent pain after surgery and its characteristics.
  
  
  METHODS
  Besides demographical data, tumor characteristics, and adjuvant treatment, we recorded type and doses of intraoperative anesthetics/analgesics (sufentanil, ketamine, clonidine, nonsteroidal anti-inflammatory drugs, MgSO4, propofol, or halogenated agents).
  
  
  RESULTS
  Of the 128 patients returning analyzable questionnaires, 43.8% reported chronic pain (48.2% with neuropathic characteristics). Multivariate logistic/linear regression model showed 4 factors independently associated with persistent pain: recall of preoperative pain (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.09-1.48), chemotherapy (OR, 1.32; 95% CI, 1.13-1.55), need for strong opioids in postanesthesia care unit (OR, 1.30; 95% CI, 1.11-1.53), and halogenated agent anesthesia (OR, 0.81; 95% CI, 0.70-0.95).
  
  
  CONCLUSIONS
  In conclusion, our study confirms the high prevalence of CPMP, 4 to 9 years after surgery. Recall of preoperative pain, chemotherapy, and need for strong opioids in the postanesthesia care unit were all associated with the presence of chronic pain. Of the intraoperative analgesics/anesthetics studied, only use of halogenated agents was associated with a lower prevalence of CPMP.
authors.affiliation: Department of Anesthesiology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium. Electronic address: arnaud.steyaert@uclouvain.be.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Steyaert
authors.affiliation: Department of Anesthesiology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
authors.forename: Patrice
authors.initials: P
authors.lastname: Forget
authors.affiliation: Department of Anesthesiology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
authors.forename: Virginie
authors.initials: V
authors.lastname: Dubois
authors.affiliation: Department of Anesthesiology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
authors.forename: Patricia
authors.initials: P
authors.lastname: Lavand'homme
authors.affiliation: Department of Anesthesiology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: De Kock
mesh_terms: D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D059350:Chronic Pain / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008408:Mastectomy / Q000009:adverse effects*; D011939:Mental Recall; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology*; D012307:Risk Factors
keywords: Breast cancer; Chronic postmastectomy pain; Chronic postsurgical pain; Postoperative pain