The efficacy of gabapentin in reducing pain intensity and morphine consumption after breast cancer surgery

AbstractAimsParenteral oxycodone is increasingly used worldwide to manage perioperative pain. Oxycodone doses required for adequate analgesia vary significantly between individuals. Our study investigated whether an analgesic plasma concentration could be determined for oxycodone and which factors affect it.Methods1000 women undergoing breast cancer surgery were recruited to the study. Demographic data were collected and their cold and heat pain sensitivity and anxiety scores were measured preoperatively. After surgery, rest and motion pain intensities were measured. Intravenous oxycodone was administered until the patients reported satisfactory pain relief (NRS <4/10). At this point, plasma concentrations of oxycodone and its metabolites were determined. A second plasma sample for oxycodone deter-mination was taken when the patient requested a new dose of oxycodone. Genomic DNA was extracted from whole blood samples and the patients were genotyped for CYP2D6, CYP3A4 and CYP3A5 variants.ResultsThe two oxycodone concentrations showed a strong correlation (r =0.84). The pain intensity measured during motion before oxycodone dosing correlated significantly with the plasma oxycodone concentration (geometric mean 35.3 ng/ml and CV % 66.4) required to achieve satisfactory analgesia (r = 0.38, p = 1.5 x 10-33). The most important factors associating with postoperative pain intensity were type of surgery (breast conserving or mastectomy with or without axillary clearance) and the age of the patient. Older patients reported lower pain scores and required smaller oxycodone concentrations for satisfactory analgesia. CYP2D6, CYP3A5 or CYP3A4 genotypes did not significantly affect the oxycodone concentrations, but CYP2D6 genotype significantly affected the formation of the metabolites oxymorphone and noroxymorphone. CYP3A4 and CYP3A5 genotypes did not affect the metabolite formation.ConclusionsOur results indicate that the more pain the patient experiences postoperatively the greater her minimum plasma oxycodone concentration must be to achieve satisfactory analgesia. Type of surgery and age significantly affect postoperative pain intensity.

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Pectoralis-II Myofascial Block and Analgesia in Breast Cancer Surgery

Anesthesiology ◽

10.1097/aln.0000000000002822 ◽

2019 ◽

Vol 131 (3) ◽

pp. 630-648 ◽

Cited By ~ 12

Author(s):

Nasir Hussain ◽

Richard Brull ◽

Colin J. L. McCartney ◽

Patrick Wong ◽

Nicolas Kumar ◽

...

Keyword(s):

Breast Cancer ◽

Side Effects ◽

Area Under Curve ◽

Relative Effectiveness ◽

Cancer Surgery ◽

Paravertebral Block ◽

Morphine Consumption ◽

Breast Cancer Surgery ◽

Rest Pain ◽

Pain Area

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Thoracic paravertebral block is the preferred regional anesthetic technique for breast cancer surgery, but concerns over its invasiveness and risks have prompted search for alternatives. Pectoralis-II block is a promising analgesic technique and potential alternative to paravertebral block, but evidence of its absolute and relative effectiveness versus systemic analgesia (Control) and paravertebral block, respectively, is conflicting. This meta-analysis evaluates the analgesic effectiveness of Pectoralis-II versus Control and paravertebral block for breast cancer surgery. Methods Databases were searched for breast cancer surgery trials comparing Pectoralis-II with Control or paravertebral block. Postoperative oral morphine consumption and difference in area under curve for pooled rest pain scores more than 24 h were designated as coprimary outcomes. Opioid-related side effects, effects on long-term outcomes, such as chronic pain and opioid dependence, were also examined. Results were pooled using random-effects modeling. Results Fourteen randomized trials (887 patients) were analyzed. Compared with Control, Pectoralis-II provided clinically important reductions in 24-h morphine consumption (at least 30.0 mg), by a weighted mean difference [95% CI] of −30.5 mg [−42.2, −18.8] (P < 0.00001), and in rest pain area under the curve more than 24 h, by −4.7cm · h [−5.1, −4.2] or −1.2cm [−1.3, −1.1] per measurement. Compared with paravertebral block, Pectoralis-II was not statistically worse (not different) for 24-h morphine consumption, and not clinically worse for rest pain area under curve more than 24 h. No differences were observed in opioid-related side effects or any other outcomes. Conclusions We found that Pectoralis-II reduces pain intensity and morphine consumption during the first 24 h postoperatively when compared with systemic analgesia alone; and it also offers analgesic benefits noninferior to those of paravertebral block after breast cancer surgery. Evidence supports incorporating Pectoralis-II into multimodal analgesia and also using it as a paravertebral block alternative in this population.

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Mapeamento dinâmico da dor aos três, seis e nove meses após a cirurgia do câncer de mama / Dynamic pain mapping at three, six and nine months after breast cancer surgery

Brazilian Journal of Development ◽

10.34117/bjdv7n11-036 ◽

2021 ◽

Vol 7 (11) ◽

pp. 102199-102216

Author(s):

Maria Luiza Pereira ◽

Luara Alves Vieira Farias ◽

Bruna Baungarten Hugen Back ◽

Natália de Souza Cunha ◽

Kamilla Zomkowski ◽

...

Keyword(s):

Breast Cancer ◽

Pain Intensity ◽

Upper Limb ◽

Cancer Surgery ◽

The Body ◽

Breast Cancer Surgery ◽

Cáncer De Mama ◽

Physical Domain ◽

Body Area ◽

Pain Frequency

Purpose: To map pain frequency and pain intensity according to activities in the physical domain of the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), at three, six and nine months after breast cancer surgery. In addition, to verify the correlation between upper limb function and pain intensity. Methods: This is a prospective cohort study, with follow-up at three time points. 22 Brazilian women diagnosed with breast cancer were included at three months after breast surgery. They performed the DASH questionnaire, the Body Pain Diagram and the Visual Analogue Scale. Frequency measures were used to analyze the frequency and intensity of pain in the items of the physical domain of the DASH. Pearson's correlation coefficient between pain intensity and the DASH total score at the three different times was calculated, a 95% confidence interval was set. Results: For twenty-two women at three, six and nine months after surgery, the body area with the highest pain frequency was the upper limb (UL) homolateral to the surgery, although, the contralateral UL was also cited as one of the areas with the highest pain frequency at sixth and ninth month. Pain intensity at three and six months remained mild and moderate in ninth month. The DASH activities with the highest pain frequency were: “putting something on a shelf above your head”, “doing heavy household chores” and “carrying a heavy object”. The correlation between pain intensity and function of the UL contralateral to surgery at nine months was strong (r=0,718; p0.01). Conclusion: The body area with the highest pain frequency at all three times points of analysis was the UL homolateral to the surgery, although the contralateral UL was also present in sixth and ninth month. There was an increase in pain intensity over time. The most painful activities were those that required large amplitudes in different planes of motion. At the ninth month, pain in the contralateral UL showed a strong correlation with limb dysfunction.

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Music Therapy Effect on the Pain of Woman after Breast Cancer Surgery

Reabilitacijos mokslai slauga kineziterapija ergoterapija ◽

10.33607/rmske.v1i14.697 ◽

2019 ◽

Vol 1 (14) ◽

Author(s):

Marija Bruner ◽

Algimantas Kirkutis ◽

Jūratė Sučylaitė

Keyword(s):

Breast Cancer ◽

Music Therapy ◽

Pain Intensity ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Control Group ◽

Study Group ◽

Therapy Effect ◽

Surgery Research ◽

And Control

Background. Pain after breast cancer surgery leads to long term disability. Music therapy is non-invasive, inexpensive supplementary therapy way, which helps to improve emotional and psychological condition, to reduce stress, anxiety and pain. Nevertheless, there is a lot of knowledge about the benefts of music therapy, and it is a lack of scientifc research, which could advocate for music therapy beneft after breast cancer surgery. Research aim. To evaluate music therapy effect on women pain after breast cancer surgery. Research tasks. To assess the pain of women using a visual analogue scale (VAS) before and after the application of music therapy in the study and control groups. Methods. An analysis of scientifc / medical literature was made. Quantitative research method was selected. Criteria for involvement into scientifc research were women after breast cancer surgery. In research group music therapy was applied. It consisted of 25 patients with an average age of 52.23 ± 9, 04 years. A control group consisted of 25 patients with an average age of 56.17 ± 7.84 years. Music therapy was not applied in control group. The research instrument was the VAS. The data were collected before the application of music therapy and after. Music therapy sessions were used after breast cancer surgery the whole period of rehabilitation. Sessions were held in a recreation room 6 times a week, session duration of 30 – minute. The Baroque and the New Age music were used in music therapy sessions. Listening to music, women were asked to close their eyes, relax and breathe deeply. To ensure the most accurate results of the study participants were asked to avoid listening additional music. Results. Before using music therapy the difference of pain intensity data (measured by VAS) was not statistically signifcant in the research and control groups. After music therapy the study group showed a statistically signifcant decrease in pain intensity: before music therapy pain intensity score of 6.54 ± 1.45, after music therapy – 3 ± 0.98 points (p < 0.001); control group pain intensity also decreased: before music therapy 5.58 ± 1.56 points, after music therapy 2.88 ± 1.91 points. Conclusion. After breast cancer surgery, and after the completed rehabilitation, pain decreased in the research group, where music therapy was applied (p < 0.001); in the control group, where music therapy was not applied, pain also decreased. (p < 0.05). Difference between the change of pain in study group and in control group was not statistically signifcant. Pain change in the study group was not signifcantly higher than the control group.Keywords: music therapy, pain, breast cancer.

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