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Pain relief following breast augmentation surgery: a comparison between incisional patient-controlled regional analgesia and traditional oral analgesia

Published online by Cambridge University Press:  19 June 2006

N. Rawal ,
A. Gupta ,
M. Helsing ,
K. Grell  and
R. Allvin
N. Rawal
Affiliation:
University Hospital, Department of Anesthesiology and Intensive Care, Örebro, Sweden
A. Gupta
Affiliation:
University Hospital, Department of Anesthesiology and Intensive Care, Örebro, Sweden
M. Helsing
Affiliation:
University Hospital, Department of Plastic Surgery, Örebro, Sweden
K. Grell
Affiliation:
University Hospital, Department of Plastic Surgery, Örebro, Sweden
R. Allvin
Affiliation:
University Hospital, Department of Anesthesiology and Intensive Care, Örebro, Sweden
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Abstract

Summary

Background and objectives: Postoperative pain is a common problem following ambulatory breast augmentation surgery. This study was performed to compare standard of care (oral analgesics) with patient-controlled incisional regional analgesia (PCRA) for postoperative pain management at home for 48 h. A second aim was to compare the analgesic efficacy of ropivacaine 0.25% vs. 0.5%. Methods: Surgery was performed under local anaesthesia and monitored anesthesia care. Sixty adults (ASA 1–2) were randomized to one of two groups. Patients in Group PCRA could self-administer ropivacaine 0.25% 10 mL in the left breast and ropivacaine 0.5% in the right breast. Patients in Group T (tablets) received our standard of care treatment, i.e. oral paracetamol 1 g four times a day and oral ibuprofen 500 mg three times a day. Parameters measured included: analgesic requirements (in post-anesthesia care unit, PACU and post-discharge), pain intensity (visual analogue scale), patient satisfaction, global analgesia, side-effects, and quality of recovery. Results: Pain scores were significantly lower in Group PCRA compared to Group T at all time periods (P < 0.05). No differences were found in pain scores between the right and left breasts. Significantly more patients in Group T requested analgesics in the recovery unit (27 vs. 7; P = 0.001) and also at home (20 vs. 11; P < 0.02). More patients in the tablet group had nausea and vomiting (10 vs. 3; P < 0.05). Global analgesia on day 2 was significantly better in PCRA group; however, patient satisfaction was similar in both groups. More patients in the tablet group had sleep disturbance and woke up at night due to pain. Conclusions: Pain relief after ambulatory breast augmentation is superior with incisional PCRA when compared to oral analgesic combination of paracetamol and ibuprofen. Incisional PCRA was associated with minimal side-effects and less sleep disturbance. There was no difference in the analgesic efficacy between ropivacaine 0.25% and 0.5%.

Keywords

PAIN ACUTE AND POSTOPERATIVESURGERY, AMBULATORYSURGERY, PLASTICANAESTHETICS LOCAL, ropivacaine
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 12 , December 2006 , pp. 1010 - 1017
Copyright
2006 European Society of Anaesthesiology

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