scholarly journals Effects of Intraoperative Low-Dose Ketamine on Persistent Postsurgical Pain after Breast Cancer Surgery: A Prospective, Randomized, Controlled, Double-Blind Study

2020 ◽  
Vol 1;23 (1;1) ◽  
pp. 37-47
Author(s):  
Ah-Reum Cho
Keyword(s):  
Breast Cancer ◽  
Study Design ◽  
Low Dose ◽  
Rating Scale ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Control Group ◽  
Double Blind Study ◽  
Postsurgical Pain ◽  
Number Of Patients

Background: Compared to acute postsurgical pain, studies regarding the role of ketamine in persistent postsurgical pain (PPSP) are limited. Objectives: The aim of this clinical trial was to test if intraoperative low-dose ketamine without postoperative infusion would reduce PPSP development after breast cancer surgery. Study design: We used a randomized, double-blinded, placebo study design. Setting: This study was conducted at Pusan National University Hospital, Republic of Korea, between December 2013 and August 2016. Methods: A total of 184 patients scheduled for breast cancer surgery were randomly assigned to either the control or ketamine group. Before skin incision, a bolus (0.5 mg/kg of ketamine or placebo), followed by a continuous infusion (0.12 mg/kg/h of ketamine or placebo), was administered until the end of the surgery. The patients were interviewed via telephone 1, 3, and 6 months after surgery. The first question was whether the patient had surgery-related pain. If answered affirmatively, questions from the Numeric Rating Scale for pain at rest (NRSr) and for coughing (NRSd) were also asked. Our primary outcome was the incidence of PPSP at 3 months after surgery. Results: For PPSP analysis, 168 patients were included. The number of patients who experienced pain was significantly lower in the ketamine group at 3 months (86.9% in the control group vs 69.0% in the ketamine group, P = .005) postoperatively. However, the NRSr and NRSd did not differ between the groups throughout the follow-up. Limitations: There were no postoperative low-dose ketamine infusion groups to compare due to hospital regulations. Dosage of ketamine was too low to reduce the severity of PPSP. And by using propofol and remifentanil for anesthesia, different results can be deduced with volatile anesthetics. Data from written questionnaires would have been more specific than telephone interviews for long-term assessment. Conclusions: Though intraoperative low-dose ketamine without postoperative infusion significantly reduced the incidence of PPSP up to 3 months after breast cancer surgery, it failed to reduce clinically significant PPSP and improve patients’ quality of life. Key words: Analgesia, breast cancer, chronic pain, ketamine, mastectomy, morphine, pain, postoperative, propofol

The effect of low dose ketamine on postoperative quality of recovery in patients undergoing breast cancer surgery: a randomized, placebo controlled trial

2019 ◽  
Author(s):  
Yuan Han ◽  
Zijian Zhao ◽  
Qiqi Xu ◽  
Yao Chen ◽  
Chen Liu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Normal Saline ◽  
Low Dose ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Control Group ◽  
Quality Of Recovery ◽  
Safety Outcomes ◽  
Postoperative Quality

Abstract Background: Intraoperative low dose ketamine has been widely studied for postoperative multimodal analgesia. However, the effect of low dose ketamine on postoperative quality of recovery in female patients undergoing breast cancer surgery has not been studied. The primary aim of this study was to assess the effects of low dose ketamine on postoperative quality of recovery in these patients using the 40-Item Quality of Recovery (QoR-40) scale. The second aim of this study was to evaluate the effects of intraoperative infusion of low-dose ketamine on chronic postoperative surgical pain (CPSP). Methods: In this prospective, randomized, double-blind trial, 100 patients planned for modified radial mastectomy were randomly assigned to one of two groups: control group (group C) and ketamine group (group K). After induction of anesthesia and before surgical incision, a bolus dose of 0.5 mg/kg ketamine or an equivalent volume of normal saline was injected followed by 0.25 mg/kg/h ketamine or normal saline infusions until skin closure. Postoperative recovery profiles, including the QoR-40 scores on postoperative day 1, numeric rating scale (NRS), and douleur neuropathique 4 (DN-4) questionnaire at postoperative month 3 were evaluated. In addition, patient characteristics, perioperative parameters, and safety outcomes were assessed. Results: Global QoR-40 scores on postoperative day 1 were not significantly different between both groups (p = 0.139). Of the five dimensions, emotional state and pain scores were significantly higher in group K than in group C (p = 0.044 and 0.023, respectively). At postoperative month 3, CPSP and neuropathic pain (NP) were not significantly different between groups (p = 0.259 and 0.959, respectively). The incidence of safety outcomes were similar between groups. Conclusion: Low dose ketamine did not improve overall quality of recovery or chronic pain in patients undergoing breast cancer surgery.

scholarly journals Thoracic Paravertebral Blockade Reduces Chronic Postsurgical Pain in Breast Cancer Patients: A Randomized Controlled Trial

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3539-3547
Author(s):  
Zeng-Mao Lin ◽  
Mu-Han Li ◽  
Feng Zhang ◽  
Xue Li ◽  
Chun-Li Shao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Randomized Controlled Trial ◽  
Neuropathic Pain ◽  
Controlled Trial ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Control Group ◽  
Single Shot ◽  
Randomized Controlled ◽  
Chronic Postsurgical Pain

Abstract Objective To evaluate the effect of multilevel single-shot thoracic paravertebral blockade (PVB) on the occurrence of chronic postsurgical pain (CPSP) in patients undergoing breast cancer surgery. Design A randomized controlled trial with two parallel groups. Setting A tertiary hospital. Methods Patients scheduled for breast cancer surgery were randomized to receive either ultrasound-guided multilevel single-shot PVB from T2 to T5 (the PVB group) or nothing (the control group). Surgery was then performed under general anesthesia. Patients were followed up for 12 months after surgery. The primary end point was incidence of CPSP at six months after surgery. Results A total of 218 patients were enrolled and randomized; of these, 208 and 204 completed six- and 12-month follow-up, respectively. The incidence of CPSP at six months was significantly lower in the PVB group (12.5% [13/104]) than in the control group (24.0% [25/104], relative risk = 0.52, 95% CI = 0.28–0.96, P = 0.031). Pain scores within 48 hours both at rest and with movement were lower in the PVB group than the control group (P = 0.006 and P < 0.001, respectively). The percentages of patients with neuropathic pain were also lower in the PVB group than the control group at both six and 12 months after surgery (P = 0.016 and 0.028, respectively). Adverse events did not differ between groups. Conclusions For patients undergoing breast cancer surgery, multilevel single-shot PVB reduces the incidence of CPSP at six months; it also improves early postoperative analgesia and reduces neuropathic pain at six and 12 months after surgery.

Effect of Rapid Rehabilitation Concepts on Quality of Life and Pain in Patients Undergoing Radical Breast Cancer Surgery in Perioperative Period

2021 ◽  
Vol 7 (5) ◽  
pp. 1538-1544
Author(s):  
Xin Li ◽  
Hai-yan An ◽  
Yi Zhao ◽  
Mingli Ji ◽  
Jing An ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Perioperative Period ◽  
Nursing Intervention ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Control Group ◽  
T Lymphocyte Subsets ◽  
Significant Difference

To study the effect of rapid rehabilitation nursing on patients’ quality of life and pain level during the perioperative period of radical breast cancer surgery. Methods: 126 patients who were hospitalized in our hospital from January 2018 to February 2020 and underwent radical breast cancer surgery were divided into control group and rapid rehabilitation group according to the perioperative period intervention method. Routine nursing intervention and rapid rehabilitation nursing intervention were used respectively. The general conditions of the two groups were recorded, and the differences of T cell subsets before operation and 3 days after operation were detected. Visual analogue pain (VAS) score was used to evaluate the changes of pain degree at 1 day, 3 days and 5 days after operation and on the day of discharge. Postoperative complications and satisfaction were compared between the two groups. Quality of life (QOL) was assessed at 1 month and 3 months after operation using the CARES-SF score. Results: Anesthesia waking time (26.12 ± 5.77) min, off-bed activity time (14.25 ± 2.87) h and hospital stay (7.82 ± 2.15) d in the rapid rehabilitation group were shorter than those in the control group (P < 0.05). The operation time (92.02 ± 14.78) min and intraoperative blood loss (57.96 ± 13.96) mL in the rapid rehabilitation group were not significantly different from those in the control group (P > 0.05). In the control group, 3d after operation, T lymphocyte subsets were decreased gradually than that before operation (P < 0.05), CD3+ was decreased 3d after operation than that before operation in the rapid rehabilitation group (P < 0.05), but CD4+, CD8+, CD4+ / CD8 + 3d after operation had no significant difference than that before operation (P > 0.05). In rapid rehabilitation group, T lymphocyte subsets at 3d after operation were higher than those in the control group (P < 0.05). The postoperative complication rate of the rapid rehabilitation group was lower than that of the control group, and the satisfaction degree was higher than that of the control group, with significant difference (P < 0.05). After follow-up, it was found that the scores of qualities of life, such as physiology, psychosocial, marriage, sexual life and relationship with medical staff in the rapid rehabilitation group were lower than those in the control group at 1 month and 3 months after operation (P < 0.05). Conclusion: The concept of rapid rehabilitation nursing can stabilize the immune function of patients after radical breast cancer surgery, promote the postoperative rehabilitation and improve the quality of life after operation.

Thoracic Paravertebral Block for Breast Cancer Surgery: A Randomized Double-Blind Study

2007 ◽  
Vol 105 (6) ◽  
pp. 1848-1851 ◽  
Author(s):  
Jytte F. Moller ◽  
Lone Nikolajsen ◽  
Svein Aage Rodt ◽  
Hanne Ronning ◽  
Palle S. Carlsson
Keyword(s):  
Breast Cancer ◽  
Cancer Surgery ◽  
Paravertebral Block ◽  
Blind Study ◽  
Breast Cancer Surgery ◽  
Double Blind Study ◽  
Double Blind ◽  
Thoracic Paravertebral Block

scholarly journals Application of MET Technique after Upper Limb Dysfunction after Breast Cancer Surgery

2021 ◽  
Vol 4 (2) ◽  
pp. 8
Author(s):  
Yanan Jin ◽  
Jingxin Wang ◽  
Huayun Liu ◽  
Jiamei Zhen
Keyword(s):  
Breast Cancer ◽  
Upper Limb ◽  
Functional Recovery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Control Group ◽  
Muscle Energy ◽  
Upper Limb Dysfunction ◽  
Experimental Group ◽  
Early Functional Recovery

Object: Explore the application and actual effect of MET (Muscle Energy) technology after breast cancer surgery with upper limb dysfunction. Methods: Taking 40 female breast cancer patients who underwent surgical treatment in our hospital from September 2017 to June 2019 as the research objects, all of them successfully completed modified radical mastectomy for breast cancer. According to different nursing methods, the patients were randomly divided into two groups. The experiment There were 20 cases in each group and the control group. The control group was given routine functional recovery exercise intervention after the operation, and the experimental group added MET technology to the base of the control group. One month after the operation, the functional recovery of the affected limbs of the two groups of patients was effectively assessed. The upper limb dysfunction of the two groups was compared by statistical methods, and the shoulder joint range of motion (ROM) was used for performance. Results: Through early functional recovery training and MET technology, 19 cases of ROM in the experimental group showed compliance (95%), compared with only 14 cases (70%) in the control group. The difference in upper limb dysfunction between the two groups is very obvious with statistical significance (P<0.05). Conclusions: Early functional recovery training combined with muscle energy technology can promote the recovery of upper limb dysfunction after breast cancer surgery faster and better, which is conducive to the recovery of patients as soon as possible and improve the quality of life.

scholarly journals Can Acute Pain Treatment Reduce Postsurgical Comorbidity after Breast Cancer Surgery? A Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Fumimasa Amaya ◽  
Toyoshi Hosokawa ◽  
Akiko Okamoto ◽  
Megumi Matsuda ◽  
Yosuke Yamaguchi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Acute Pain ◽  
Pain Treatment ◽  
Cancer Recurrence ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Regional Analgesia ◽  
Postsurgical Pain ◽  
Analgesic Regimen ◽  
Definition Of

Regional analgesia, opioids, and several oral analgesics are commonly used for the treatment of acute pain after breast cancer surgery. While all of these treatments can suppress the acute postsurgical pain, there is growing evidence that suggests that the postsurgical comorbidity will differ in accordance with the type of analgesic used during the surgery. Our current study reviewed the effect of analgesics used for acute pain treatments on the major comorbidities that occur after breast cancer surgery. A considerable number of clinical studies have been performed to investigate the relationship between the acute analgesic regimen and common comorbidities, including inadequate quality of recovery after the surgery, persistent postsurgical pain, and cancer recurrence. Previous studies have shown that the choice of the analgesic modality does affect the postsurgical comorbidity. In general, the use of regional analgesics has a beneficial effect on the occurrence of comorbidity. In order to determine the best analgesic choice after breast cancer surgery, prospective studies that are based on a clear definition of the comorbidity state will need to be undertaken in the future.

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