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Pain relief following breast augmentation surgery: a comparison between incisional patient-controlled regional analgesia and traditional oral analgesia

Published online by Cambridge University Press:  19 June 2006

N. Rawal ,
A. Gupta ,
M. Helsing ,
K. Grell  and
R. Allvin
N. Rawal
Affiliation:
University Hospital, Department of Anesthesiology and Intensive Care, Örebro, Sweden
A. Gupta
Affiliation:
University Hospital, Department of Anesthesiology and Intensive Care, Örebro, Sweden
M. Helsing
Affiliation:
University Hospital, Department of Plastic Surgery, Örebro, Sweden
K. Grell
Affiliation:
University Hospital, Department of Plastic Surgery, Örebro, Sweden
R. Allvin
Affiliation:
University Hospital, Department of Anesthesiology and Intensive Care, Örebro, Sweden
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Abstract

Summary

Background and objectives: Postoperative pain is a common problem following ambulatory breast augmentation surgery. This study was performed to compare standard of care (oral analgesics) with patient-controlled incisional regional analgesia (PCRA) for postoperative pain management at home for 48 h. A second aim was to compare the analgesic efficacy of ropivacaine 0.25% vs. 0.5%. Methods: Surgery was performed under local anaesthesia and monitored anesthesia care. Sixty adults (ASA 1–2) were randomized to one of two groups. Patients in Group PCRA could self-administer ropivacaine 0.25% 10 mL in the left breast and ropivacaine 0.5% in the right breast. Patients in Group T (tablets) received our standard of care treatment, i.e. oral paracetamol 1 g four times a day and oral ibuprofen 500 mg three times a day. Parameters measured included: analgesic requirements (in post-anesthesia care unit, PACU and post-discharge), pain intensity (visual analogue scale), patient satisfaction, global analgesia, side-effects, and quality of recovery. Results: Pain scores were significantly lower in Group PCRA compared to Group T at all time periods (P < 0.05). No differences were found in pain scores between the right and left breasts. Significantly more patients in Group T requested analgesics in the recovery unit (27 vs. 7; P = 0.001) and also at home (20 vs. 11; P < 0.02). More patients in the tablet group had nausea and vomiting (10 vs. 3; P < 0.05). Global analgesia on day 2 was significantly better in PCRA group; however, patient satisfaction was similar in both groups. More patients in the tablet group had sleep disturbance and woke up at night due to pain. Conclusions: Pain relief after ambulatory breast augmentation is superior with incisional PCRA when compared to oral analgesic combination of paracetamol and ibuprofen. Incisional PCRA was associated with minimal side-effects and less sleep disturbance. There was no difference in the analgesic efficacy between ropivacaine 0.25% and 0.5%.

Keywords

PAIN ACUTE AND POSTOPERATIVESURGERY, AMBULATORYSURGERY, PLASTICANAESTHETICS LOCAL, ropivacaine
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 12 , December 2006 , pp. 1010 - 1017
Copyright
2006 European Society of Anaesthesiology

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References

Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg 1997; 85: 808–816.Google Scholar
Beauregaard L, Pomp A, Choinière M. Severity and impact of pain after day-surgery. Can J Anaesth 1998; 45: 304–311.Google Scholar
Rawal N, Hylander J, Nydahl P-Aet al. Survey of postoperative analgesia following ambulatory surgery. Acta Anaesthesiol Scand 1997; 41: 1017–1022.Google Scholar
Wu CL, Berenholtz SM, Pronovost PJet al. Systematic review and analysis of postdischarge symptoms after outpatient surgery. Anesthesiology 2002; 96: 994–1003.Google Scholar
McGrath B, Elgendy H, Chung Fet al. Thirty percent patients have moderate to severe pain 24 h after ambulatory surgery: a survey of 5703 patients. Can J Anesth 2004; 51: 886–891.Google Scholar
Rawal N, Allvin R, Amilon Aet al. Postoperative analgesia at home after ambulatory hand surgery: a controlled comparison of Tramadol, Metamizol, and Paracetamol. Anesth Analg 2001; 92: 347–351.Google Scholar
Rawal N, Axelsson K, Hylander Jet al. Postoperative patient-controlled local anesthetic administration at home. Anesth Analg 1998; 86: 86–89.Google Scholar
Ilfeld B, Morey T, Kayser Enneking F. Continuous intraclavicular brachial plexus block for postoperative pain control at home: a randomized, double-blind, placebo-controlled study. Anesthesiology 2002; 96: 1297–1304.Google Scholar
Klein SM. Beyond the hospital: continuous peripheral nerve blocks at home (Editorial). Anesthesiology 2002; 96: 1283–1285.Google Scholar
Fredman B, Shapiro A, Zohar Eet al. The analgesic efficacy of patient-controlled ropivacaine instillation after Caesarean delivery. Anesth Analg 2000; 91: 1436–1440.Google Scholar
Reuben S, Connelly NR, Maciolek H. Postoperative analgesia with controlled-release Oxycodone for outpatient anterior cruciate ligament surgery. Anesth Analg 1999; 88: 1286–1291.Google Scholar
Czarnecki M, Jandrisevits M, Theiler Set al. Controlled-release oxycodone for the management of pediatric postoperative pain. J Pain Sympt Manage 2004; 27: 379–386.Google Scholar
Chang D, Desjardins P, King Thomaset al. The analgesic efficacy of etoricoxib compared with oxycodone/acetaminophen in an acute postoperative pain model: a randomized, double-blind clinical trial. Anesth Analg 2004; 99: 807–815.Google Scholar
Korn S, Vassil T, Kotey Pet al. Comparison of rofecoxib and oxycodone plus acetaminophen in the treatment of acute pain: a randomized, double-blind, placebo-controlled study in patients with moderate to severe postoperative pain in the third molar extraction model. Clin Therap 2004; 26: 769–778.Google Scholar
Sunshine A, Olson NZ, Colon Aet al. Analgesic efficacy of controlled-release oxycodone in postoperative pain. J Clin Pharmacol 1996; 36: 595–603.Google Scholar
Taylor MS. Managing postoperative pain. Hosp Med 2001; 62: 560–563.Google Scholar
G. Percocet prescribing information (oxycodone and acetaminophen combination tablet).Physicians' Desk Reference, 54th edn.Montvale, NJ: Medical Economics, 2000: 1037–1038.
Zohar E, Fredman B, Phillipov Aet al. The analgesic efficacy of patient-controlled bupivacaine wound instillation after total abdominal hysterectomy with bilateral salpingo-oophorectomy. Anesth Analg 2001; 93: 482–487.Google Scholar
White PF, Rawal S, Latham Pet al. Use of continuous local anesthetic infusion for pain management after median sternotomy. Anesthesiology 2003; 99: 918–923.Google Scholar
Axelsson K, Nordenson U, Johanzon Eet al. Patient-controlled regional analgesia (PCRA) with ropivacaine after arthroscopic subacromial decompression. Acta Anaesthesiol Scand 2003; 47: 993–1000.Google Scholar