Persistent Postmastectomy Pain and Pain-Related Physical and Emotional Functioning With and Without a Continuous Paravertebral Nerve Block: A Prospective 1-Year Follow-Up Assessment of a Randomized, Triple-Masked, Placebo-Controlled Study.

Autor: Ilfeld, Brian, Madison, Sarah, Suresh, Preetham, Sandhu, NavParkash, Kormylo, Nicholas, Malhotra, Nisha, Loland, Vanessa, Wallace, Mark, Mascha, Edward, Xu, Zekun, Wen, Cindy, Morgan, Anya, Wallace, Anne
Zdroj: Annals of Surgical Oncology: An Oncology Journal for Surgeons; Jun2015, Vol. 22 Issue 6, p2017-2025, 9p
Abstrakt: Background: In a previous randomized, triple-masked, placebo-controlled study, the authors demonstrated that extending a single-injection paravertebral nerve block with a multiple-day perineural local anesthetic infusion improves analgesia and decreases pain-related dysfunction during the 3-day infusion but not subsequent to catheter removal within 1 month after mastectomy. This report describes a prospective follow-up study of the previously published trial to investigate the possibility that extending a single-injection paravertebral block with a multiple-day infusion may decrease persistent postsurgical pain as well as pain-induced emotional and functional dysfunction 1 year after mastectomy. Methods: Subjects undergoing uni- or bilateral mastectomy received unilateral ( n = 24) or bilateral ( n = 36) single-injection thoracic paravertebral block(s) with ropivacaine and perineural catheter(s). The subjects were randomized to receive either ropivacaine 0.4 % ( n = 30) or normal saline ( n = 30) via their catheters until the catheters were removed on postoperative day 3. Chronic pain and pain-related physical and emotional dysfunction were measured using the Brief Pain Inventory (BPI). Results: No statistically significant difference between treatments 3 months after surgery was observed with the BPI. In contrast, after 12 months, only 4 subjects (13 %) who had received a perineural ropivacaine infusion reported pain-induced dysfunction compared with 14 (47 %) who had received saline infusion ( P = 0.011). At 12 months, the mean BPI was 1.6 ± 4.6 for the subjects who received ropivacaine versus 5.9 ± 11.3 for the subjects who received saline ( P = 0.007). Conclusions: Adding a multiple-day, continuous ropivacaine infusion to a single-injection ropivacaine paravertebral nerve block may result in a lower incidence of pain as well as pain-related physical and emotional dysfunction 1 year after mastectomy. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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