Persistent postdischarge pain and chronic postoperative pain after breast cancer surgery under general anesthesia and single-shot paravertebral block: incidence, characteristics and impact on quality of life and healthcare costs

Andrea Saporito, José Aguirre, Alain Borgeat, Andreas Perren, Luciano Anselmi, Roberto Poggi, Bruno Minotti, Stefano Cafarotti, Davide La Regina, Samuele Ceruti, Andrea Saporito, José Aguirre, Alain Borgeat, Andreas Perren, Luciano Anselmi, Roberto Poggi, Bruno Minotti, Stefano Cafarotti, Davide La Regina, Samuele Ceruti

Abstract

Introduction: Breast surgery is associated with persistent postsurgical pain; usually related to poorly treated acute pain. Paravertebral block has been successfully employed in analgesic protocols for breast surgery; its impact on postdischarge pain (PDP) has not been investigated. The aim of this study was to assess characteristics of PDP after breast surgery, the development of chronic postoperative pain (CPP) and its impact on health care costs. Methods: We conducted a retrospective, observational study on a continuous cohort of adult female patients undergoing local breast cancer surgery under combined anesthesia. All patients were interviewed 6 months after hospital discharge. The survey was specifically conceived to assess incidence, features and duration of PDP. The overall cost of additional healthcare resources consumed with a specific relationship to persistent PDP was estimated. Results: A database of 244 patients was preliminarily analyzed. Of these, 188 were included in the following statistical analysis; 123 patients (65.2%) reported significant PDP, with a median intensity on NRS of 6 (IQR=2), more frequently described as burning and associated with paresthesia and/or hyperalgesia (87 patients, 46%). One hundred and six patients (56.5%) reported this pain as interfering with their normal daily activities, work and sleep. In 26.8% of cases (50 patients) symptoms lasted more than 1 month and in 28 patients (15.0%) pain became chronic. The majority of patients self-treated their pain with non-steroideal anti-inflammatory drugs, but in 50 patients (26.8%) this therapy was reported as ineffective. This additional consumption of healthcare resources led to a significant economical impact. Conclusion: PDP and CPP seem to be common complications after breast cancer surgery, even if a combined anesthesia technique with a thoracic paravertebral block is performed, leading to severe consequences on patients' quality of life and increasing consumption of healthcare resources after discharge. Trial number: NCT03618459 (www.clinicaltrials.gov).

Keywords: breast surgery; paravertebral block; postoperative pain; regional anesthesia.

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Percentage of patients affected by postdischarge pain at discharge, at 1 month, at 3 months and during the interview at 6 months. Median Numerical Rating Scale pain perception was 6 (IQR=2).
Figure 2
Figure 2
Patients’ evaluation of regional anesthesia effect. Regional anesthesia was considered adequate if evaluated as sufficient, good or perfect.
Figure 3
Figure 3
Global intra-hospital analgesia efficacy, evaluated by patients. Global analgesia was considered adequate if evaluated as sufficient, good or perfect.

References

    1. Cronin-Fenton DP, Norgaard M, Jacobsen J, et al. Comorbidity and survival of Danish breast cancer patients from 1995 to 2005. Br J Cancer. 2007;96:1462–1468. doi:10.1038/sj.bjc.6603717
    1. Andersen KG, Kehlet H. Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention. J Pain. 2011;12:725–746. doi:10.1016/j.jpain.2010.12.005
    1. Macdonald L, Bruce J, Scott NW, Smith WC, Chambers WA. Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome. Br J Cancer. 2005;92:225–230. doi:10.1038/sj.bjc.6602304
    1. Peuckmann V, Ekholm O, Rasmussen NK, et al. Chronic pain and other sequelae in long-term breast cancer survivors: nationwide survey in Denmark. Eur J Pain. 2009;13:478–485. doi:10.1016/j.ejpain.2008.05.015
    1. Blyth FM, March LM, Brnabic AJ, Cousins MJ. Chronic pain and frequent use of health care. Pain. 2004;111:51–58. doi:10.1016/j.pain.2004.05.020
    1. Blyth FM, March LM, Cousins MJ. Chronic pain-related disability and use of analgesia and health services in a Sydney community. Med J Aust. 2003;179:84–87.
    1. Correl D. Chronic postoperative pain: recent finding in understanding and management. Research. 2017;6:1054.
    1. Schreiber KL, Martel MO, Shnol H, et al. Persistent pain in postmastectomy patients: comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain. Pain. 2013;154(5):660–668. doi:10.1016/j.pain.2012.11.015
    1. Pham QH, Li SX, Williams BC, Factors R. Effects of care management on hospital readmissions among high users at an academic medical center. Care Manag J. 2016;17(3):134–139. doi:10.1891/1521-0987.17.3.134
    1. Andreae MH, Andreae DA. Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery. Cochrane Database Syst Rev. 2012;17(10):CD007105.
    1. Hussain N, Shastri U, Cjl M, et al. Should thoracic paravertebral blocks be used to prevent chronic postsurgical pain after breastcancer surgery? A systematic analysis of evidence in light of IMMPACT recommendations. Pain. 2018;159(10):1955–1971. doi:10.1097/j.pain.0000000000001292
    1. Mejdahl MK, Andersen KG, Gärtner R, Kroman N, Kehlet H. Persistent pain and sensory disturbances after treatment for breast cancer: six-year nationwide follow-up study. BMJ. 2013;346:f1865. doi:10.1136/bmj.f1164.
    1. Rasu RS, Vouthy K, Crowl AN, et al. Cost of pain medication to treat adult patients with non-malignant chronic pain in the United States. J Manag Care Pharm. 2014;20(9):921–928.
    1. Physicians Desk Reference. Red Book 2009: Pharmacy’s Fundamental Reference. 113th ed. Montvale (NJ): Thomson Reuters; 2009.
    1. Centers for Disease Control and Prevention. Ambulatory health care data. Available from: . Accessed June29, 2014.
    1. Smith BH, Torrance N. Management of chronic pain in primary care. Curr Opin Support Palliat Care. 2011;5(2):137–142. doi:10.1097/SPC.0b013e328345a3ec
    1. Breivik H, Collet B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333. doi:10.1016/j.ejpain.2005.06.009
    1. Jouguelet-Lacoste J, La Colla L, Schilling D, Chelly JE. The use of intravenous infusion or single dose of low-dose ketamine for postoperative analgesia: a review of the current literature. Pain Med. 2015;16(2):383–403. doi:10.1111/pme.12619

Source: PubMed

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