medigraphic.com

2004, Number 5

<< Back Next >>

Cir Cir 2004; 72 (5)

Analgesic alternatives for the control of postoperatory pain in radical mastectomy

González-Arrieta ML, Martínez-Huerta MA, Ramírez-Ramírez ML

Language: Spanish
References: 29
Page: 363-368
PDF size: 84.85 Kb.


ABSTRACT

Introduction: The purpose of preventive analgesia based on regional blocks with local anesthetics is to avoid sharp and hard-to-control pain in the anterior side of thorax and axilla secondary to radical mastectomy. Objective: Our aim was to compare the analgesic effectiveness of direct trans-operational block applied to nerves vs conventional analgesia using analgesic-antipiretic and antiinflammatory (AINES) drugs. Material and methods: We designed a 1-year case-control study at the Hospital de Oncología of the Instituto Mexicano del Seguro Social’s (IMSS’s) Centro Médico Nacional Siglo XXI (CMN-SXXI) in Mexico City. A total of 112 patients were mastectomized under general anesthesia: Thirty one patients received preventive analgesia (cases) by direct transoperational infiltration of brachial and intercostal nerves III-VI; bupivacaine 1 mg/kg and buprenorphine 0.005 mg/kg in 15 ml were distributed among appropriate nerves accompanied by a single dose of AINES in emersion stage; during anesthetic emersion, 81 patients received conventional analgesia (control), including endovenous AINES alone or combined, and buprenorphine 0.3 mg or nalbuphine 10 mg. Three evaluations employing analog visual scale were conducted: recovery (immediate post surgery); floor (mediate), and following day. Results: We studied 110 women and two men. Demographic, laboratory, anesthetic, and surgical variables were similar in both groups (p = not significant [ns]). In no case was post-surgical pain reported. Among controls, slight pain was reported by 13 patients, moderate pain by 66, and severe pain was reported by two patients, whereas in patients returned to their rooms on the floor, slight pain was reported by 38, moderate by 42, and severe by one. Finally, on the following day all patients reported slight pain. Types of pain included 15 patients with somatic pain, 10 with neuropathic, and 56 patients with mixed pain (p <0.0001). Conclusions: Preventive analgesia by direct transoperational block on nerves turned out to be an effective alternative with low level of systemic morbidity, which must be considered to prevent moderate and severe pain syndromes that are difficult to control in thoracic oncological surgery.


REFERENCES

  1. Crile GW. The kinetic theory of shock and its prevention through anoci-association (shockless operation). Lancet 1913;185:7-16.

  2. Wilder-Smith OH, Tassonyi E, Crul BJ, Arendt-Nielsen L. Quantitative sensory testing and human surgery. Effects of analgesic management on postoperative neuroplasticity. Anesthesiology 2003;98: 1214-1222.

  3. Katz J, et al. Preemptive analgesia. Anesthesiology 1992;77:439-446.

  4. Kissin I. Preemptive analgesia: why its effect is not always obvious. Anesthesiology 1996;84(5):1015-1019.

  5. McCartney CJ, Sinha A, Katz J. A qualitative systematic review of the role of N-methyl-D-aspartate receptor antagonists in preventive analgesia. Anesth Analg 2004;98:1385-1400.

  6. Leach A. Old ideas, new applications. Br J Anesth Anaesthesiol 1998;89:500-506.

  7. Bard M, Sutherland AM. Psychological impact of cancer and its treatment. Adaptation to radical mastectomy. Cancer 1955;8:652-672.

  8. Perkins GH, Middleton L. Breast cancer in men. Br Med J 2003;327 (7409):238-240.

  9. Secretaría de Salud, Dirección General de Estadística e Informática. Incidencia y prevalencia de cáncer en México. Salud Publica Mex 1996;38:75-81.

  10. Borgen PI, Wong GY, Vlamis V. Current management of male breast cancer: a review of 104 cases. Ann Surg 1992;215(5):451-459.

  11. Belfer I, Wu T, Kingman A, Krishnaraju RK, Goldman D, Max MB. Candidate gene studies of human pain mechanisms. Anesthesiology 2004;100:1562-1572.

  12. Prithvi R. Tratamiento práctico del dolor. USA: Mosby/Doyma; 1995. p. 7.

  13. Arner S, Meyerson BA. Lack of analgesic effect of opioids on neuropathic and idiopathic forms of pain. Pain 1988;33:11-23.

  14. Martínez-Huerta MA, González-Arrieta ML. Anestesia para mastectomía radical en un hospital oncológico. Rev Med IMSS 2003;41(2): 127-131.

  15. Spruce MC, Potter J, Coppini DV. The pathogenesis and management of painful diabetic neuropathy: a review. Diab Med 2003;20:88-98.

  16. Orazio C, Maurizio A, Antonella F, Lucenti A, Valduga F, Enzo G. Pain and quality of life after surgery for breast cancer. Breast Cancer Res Treat 2003;80(1):39-48.

  17. Suresh S, Barcelona SL, Young NM, Heffner CL, Coté C. Does a preemptive block of the great auricular nerve improve postoperative analgesia in children undergoing tympanomastoid surgery? Anesth Analg 2004;98:330-333.

  18. Wurm WH, Concepción M, Sternlicht A, Carabuena JM, Robelen G, Goudas L, et al. Preoperative interscalene block for elective shoulder surgery: loss of benefit over early postoperative block after patient discharge to home. Anesth Analg 2003;97:1620-1626.

  19. Marret E, Flahault A, Samama C, Bonnet F. Effects of postoperative, nonsteroidal, antiinflammatory drugs on bleeding risk after tonsillectomy. Meta-analysis of randomized, controlled trials. Anesthesiology 2003;98:1497-1502.

  20. Beilin B, Shavit Y, Trabekin E, Mordashev B, Mayburd E, Zeidel A, Bessler H. The effects of postoperative pain management on immune response to surgery. Anesth Analg 2003;97:822-827.

  21. Quinn H, Setephen E. Neural blockade for diagnosis and prognosis: a review. Anesthesiology 1997;86(1):216-241.22. Moraca RJ, Sheldon DG, Thirlby RC. The role of epidural anesthesia and analgesia in surgical practice. Ann Surg 2003;238:663-673.

  22. Kwok RF, Lim J, Chan MT, Gin T, Chiu W. Preoperative ketamine improves postoperative analgesia after gynecologic laparoscopic surgery. Anesth Anal 2004;98:1044-1049.

  23. Rosseland L, Helgesen K, Breivik H, Stubhaug A. Moderate to severe pain after knee arthroscopy is releved by intrarticular saline: a randomized controlled trial. Anesth Analg 2004;98:1546-1551.

  24. Bromage P. Analgesia peridural. España: Editorial Salvat; 1984. pp. 335-387.

  25. Torres LM, editor. Medicina del dolor. Barcelona, España: Editorial Masson; 1997.27. Wall PD. Introduction. Textbook of pain. 2nd ed. Edinburgh, UK: Churchill Livingstone; 1989.

  26. Lewis CD. Control of postoperative pain. Nonnarcotic and narcotic alternatives and their effect on pulmonary function. Chest 1987;92(3): 520-527.

  27. Belfer I, Wu T, Kingman A, Krishnaraju R, Goldman D, Max MB. Candidate gene studies of human pain mechanisms. Anesthesiology 2004;100:1562-1572.

  28. Roberts J, Morrow J. Analgesic-antipiretic and antiinflammatory agents and drugs employed in the treatment of gout. In: Goodman & Gilman’s. The pharmacological basis of therapeutics. 10th ed. USA: McGraw-Hill; 2001. pp. 687-731.




2020     |     www.medigraphic.com