B23

Use of local anaesthetics in breast cancer surgery

Hudhaifah Shaker, G Mahadev

South Manchester University Hospitals, Manchester, UK

Background
Surgery is usually the first line of treatment in Breast Cancer.
Postoperative pain is a significant factor in postoperative morbidity. Infiltration with local anaesthetics (LA) is known to reduce pain and analgesic requirement. Little evidence exists of use of LA in patients undergoing breast surgery. LAs do have uncommon but significant adverse effects. Our aim was to assess the evidence for the use of LA, optimal timing and complications of LA in breast cancer surgery

Method
A literature search was conducted with the words breast surgery, local anaesthetic and several related keywords using Pubmed, MESH, Cochrane database & Cochrane Review. Cosmetic breast surgery was excluded.

Results
Eight RCTs were found: 6 were carried out in mastectomy patients, 1 in patients undergoing lumpectomy and 1 for breast biopsies under GA. Two studies used topical LA while the remainder used infiltration of either bupivacaine or ropivacaine alone. The mean number of patients in each study was 71 (range 30 -120). Three studied pre-incision LA Vs pre-closure, 3 looked at pre-closure Vs placebo and 2 studied pre-incision Vs placebo. No difference was found in pain scores and analgesic requirements between pre-incision and pre-closure LA. Four studies showed a reduction in pain with LA which was usually early (<6 hours post op) while one study also found a significant reduction in pain at 3 months. Two studies showed no difference between placebo and LA. There was no difference in post-operative complications. No study documented at mortality

Conclusion
The use of LA in patients undergoing breast cancer surgery can reduce pain in the early postoperative period however the evidence to support this is not overwhelming. There is no difference between giving LA pre-incision or pre-closure. Only one study has studied the effect of LA on long term pain. More studies are needed to assess the usefulness (and safety) of using LA to control postoperative pain in breast surgery as well as to identify the optimal drug and method of administration.