Local anesthetic delivery via surgical drain provides improved pain control versus direct skin infiltration following axillary node dissection for breast cancer
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Axillary node dissection has a central role in the surgical management of breast cancer; however, it is associated with a significant risk of lymphoedema and chronic pain. Peri-operative administration of local anesthesia reduces acute and persistent post-surgical pain, but there is currently no consensus on the optimal method of local anesthetic delivery.
Patients undergoing axillary dissection for breast cancer were randomly assigned to receive a one-off dose of levobupivacaine 0.5% (up to 2 mg/kg) following surgery, either via the surgical drain or by direct skin infiltration. Post-operative pain control at rest and on shoulder abduction was assessed using a numerical rating scale. Total analgesia consumption 48 h after surgery was also recorded.
Pain scores were significantly lower when local anesthesia was administered via surgical drain at both 3 and 12 h after surgery; this trend extended to 24 h post-operatively. However, pain scores on shoulder abduction did not differ at the 12 or 24 h time points. No differences were found in the total analgesia consumption or length of hospital stay between treatment groups.
This study demonstrates that local anesthetic delivery via a surgical drain provides improved pain control compared to direct skin infiltration following axillary node dissection. This is likely to be important for the management of acute pain in the immediate post-operative period; however, further studies may be required to validate this in specific patient subgroups, e.g., breast-conserving surgery versus mastectomy.
KeywordsBreast neoplasms Lymph node excision Anesthesia, local Pain, post-operative
We thank Medway Maritime Foundation Trust for their support and facilities and the research team for their help with protocol development, power calculation, and ethics approval. We further thank Miss Nasreen Davarpanah and Mr. Ahmed Ibrahim for their support in the initial stages of the study, and the Breast Surgery Nurses for their assistance with patient recruitment and data collection.
MK: PI of the investigation, study design and protocol, data analysis and paper writing. JRCM: Data analysis and paper writing. ZP: Co-supervisor, advised on study design and protocol. DH: Project supervision, advised on study design and protocol, organized patient recruitment and data collection, and performed axillary node dissection.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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