Strazisar, B., Besic, N., & Ahcan, U. (2014). Does a continuous local anaesthetic pain treatment after immediate tissue expander reconstruction in breast carcinoma patients more efficiently reduce acute postoperative pain—A prospective randomised study. World Journal of Surgical Oncology, 12(16). 

To determine if continuous wound infusion of a local anesthetic reduces postoperative pain, opioid consumption, and chronic pain compared to standard piritramide intravenous infusion

Patients scheduled for primary breast reconstruction with a tissue expander or for prophylactic mastectomy were randomized preoperatively to receive the local anesthetic wound infusion or standard intravenous analgesia. All subjects had the same anesthesia for the procedure. A fenestrated wound catheter was placed into the wound cavity in the experimental group. A continuous infusion of 0.25% levobupivacaine at 2 ml per hour was provided and the catheter was removed after 50 hours. Control patients were on a continuous IV infusion with piritramide, metoclopramide, and metamizole after surgery for 24 hours. An IV bolus of rescue analgesia was provided to patients in both groups as needed. Pain data were obtained by nursing staff in the recovery room at three, six, and nine hours after surgery and then every eight hours for three days. Three months after surgery, pain was assessed. Opioid consumption after surgery and alertness were evaluated.

• N = 60  
• MEAN AGE = 47.8 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Breast cancer surgery
• OTHER KEY SAMPLE CHARACTERISTICS: American Society of Anesthesiologists score for the surgical procedure was not significantly different between groups

• SITE: Single-site    
• SETTING TYPE: Inpatient    
• LOCATION: Slovenia

• PHASE OF CARE: Active antitumor treatment

Randomized, controlled trial

• Visual Analog Scale (VAS) for pain – median scores of all measures on the day of surgery and the first day postoperatively were used.

There were no local signs of complications where wound catheters were inserted and no differences between groups in postoperative complications. Consumption of piritramide in the first 24 hours after surgery was lower in the experimental group (p < .0001). Alertness six hours after surgery was higher in the experimental group (p < .0001). Patients in the experimental group reported less nausea and consumed less metoclopramide (p < .0001). Three months after surgery in the treatment and control groups, pain was reported in 16.7% and 50% of patients, respectively (p = .01).

The findings showed that continuous wound infusion of local anesthetic after primary breast reconstruction reduced pain immediately after surgery and for the first postoperative day.

• Small sample (< 100)
• Risk of bias (no blinding)

Continuous local anesthetic wound infusion postoperatively was associated with reduced short-term postoperative pain and less chronic pain after breast reconstruction. Similar findings have been seen with other types of surgical procedures. Nurses can advocate for consideration of this approach for acute pain management in surgical cases.