The use of regional anaesthetic blocks and local wound anaesthetic injection for the management of postoperative pain in breast cancer surgery - prospective study

Introduction. Breast cancer is one of the most frequent diagnosed cancers in women worldwide. Even though the extent of radical surgery has dropped, in the past decades, the percentage of mastectomies performed is still high. Immediate postoperative pain is correlated to the prevalence of chronic reported pain. NSAIDs are considered not enough for the management of subjective local pain reported by breast cancer patients. For this matter, regional anaesthetic blocks, wound anaesthetic injections or a combinations of thereof, have provided successful and promising results. The aim of this study was to assess and compare the impact of postoperative pain on the quality of life in breast cancer surgery, both in patients who have undergone regional (pectoral, paravertebral or wound infiltration) anaesthetic block and in those who have not been given local anaesthetic for pain control, and, further on, to compare the subjective perceived pain in the same group of patients. Patients and Methods. We have prospectively selected a preliminary cohort of 20 breast cancer patients irrespective of neoadjuvant chemotherapy, operated in a tertiary Surgical facility by a single surgical team, either via a conservative or via a radical approach. All relevant demographics and cancer-related data was recorded. We have reported and compared the pain scores (McGil and Present Pain Intensity-PPI) in relation to the surgical approach. Results. The average age of patients was 53.75 ± 12.51 years, with more patients coming from a rural setting, bearing a right upper outer quadrant tumour (45%), being subjected to radical surgery (55%), with more than half of the patients without any neoadjuvant treatment. In the current study, 65% of the patients received some sort of regional or local analgesia as adjuvant to usual NSAIDs treatment. Pain reported at 2 months (McGill score) versus pain reported at 6 months postoperatively (PPI score) revealed a decrease both for patients treated with conservative and radical surgery (p