Post-discharge Pain After Breast-surgery Treated by Paravertebral Block
Kľúčové slová
Abstrakt
Popis
Breast cancer is the most frequent cancer in women, with an incidence of more than one million new cases per year. In the majority of cases surgery is part of the treatment and prognosis has progressively improved during last years. Attention is thus being increasingly focusing on these patients' quality of life and chronic postsurgical pain, defined as pain in the area of surgery lasting beyond 3 month from the operation, has emerged as a frequent long-term complication, with prevalence up to 60%. This often-disabling condition has been shown to significantly affect cancer survivors' quality of life and to have a heavy economic impact on the healthcare system.
Many potential risk factors have been proposed for the development of chronic post-breast surgery pain. A Cochrane systematic review has addressed the role of regional anesthesia in preventing the development of chronic postoperative pain, suggesting that "paravertebral block may reduce the pain after breast cancer surgery in about one out every five women treated", these results being however weakened by the often poor quality and inadequate power of the studies available. Many predictors of chronic postoperative pain have been identified, one of them being a poorly treated acute pain; in this perspective, regional anesthesia could possibly play a role in preventing nervous system remodeling with resultant hyperalgesia, allodynia and sustained wound pain.
Even if chronic postoperative pain has been progressively recognized as an issue after breast cancer surgery, its link to poorly treated acute postoperative pain and post-discharge pain (PDP) has been poorly investigated. Single shot paravertebral block is an effective technique to provide both anesthesia and good analgesia after breast surgery, but its benefits duration is still debated.
Termíny
Naposledy overené: | 07/31/2018 |
Prvý príspevok: | 07/25/2018 |
Odhadovaná registrácia bola odoslaná: | 07/31/2018 |
Prvý príspevok: | 08/06/2018 |
Posledná aktualizácia bola odoslaná: | 07/31/2018 |
Posledná aktualizácia bola zverejnená: | 08/06/2018 |
Aktuálny dátum začatia štúdie: | 12/31/2015 |
Odhadovaný dátum dokončenia primárneho okruhu: | 04/29/2017 |
Odhadovaný dátum dokončenia štúdie: | 06/29/2017 |
Stav alebo choroba
Intervencia / liečba
Other: Breast-surgery patients
Fáza
Skupiny zbraní
Arm | Intervencia / liečba |
---|---|
Breast-surgery patients A consecutive cohort of adult patients undergoing breast surgery with a combined anesthesia technique, employing a thoracic single-shot paravertebral block performed before surgery. Operations performed were in all cases unilateral tumor resections, lumpectomies and mastectomies without axillary lymphadenectomy. | Other: Breast-surgery patients Patients were contacted by phone 6 months after surgery and, after oral consent, a standardized questionnaire was administered in order to inquiry about the length and nature of post-operative pain, the incidence of post-discharge pain, its characteristics, its impact on daily life, its treatment and its rate of chronicity |
Kritériá oprávnenosti
Vek vhodný na štúdium | 18 Years To 18 Years |
Pohlavia vhodné na štúdium | Female |
Metóda vzorkovania | Non-Probability Sample |
Prijíma zdravých dobrovoľníkov | Áno |
Kritériá | Inclusion Criteria: - female sex - 18 years or greater - elective breast surgery (tumor resection, mastectomy, lumpectomy) - local regional anesthesia Exclusion Criteria: - patients refusal, - general contraindications to regional anesthesia, - the inability to perform a complete block - diagnosed COPD or other respiratory diseases, - ASA score risk greater than 3. |
Výsledok
Primárne výstupné opatrenia
1. Post-discharge pain [6 months post-surgery]
Opatrenia sekundárnych výsledkov
1. Pain characteristics [6 months post-surgery]
2. Pain impact [6 months post-surgery]