Instilling bupivacaine on wound beds- Simple and Safe Analgesia after Modified Radical Mastectomy

Surgery is critical in the treatment of breast cancer. Regrettably, no progress has been achieved in terms of postoperative pain management after modified radical mastectomy (MRM).

Approximately one out of every two patients still has significant postoperative discomfort after breast surgery nowadays. Numerous pain-management techniques are utilised to alleviate post-surgical discomfort. While opioids, non-steroidal anti-inflammatory medications (NSAIDs), and interventional regional anaesthetic procedures are all effective, each treatment has certain associated risks.

A recently published research suggests a very easy, safe, and effective technique of pain management after modified radical mastectomy (MRM) which is Instilling bupivacaine through surgical drains on wound beds.

The purpose of this research was to investigate the effectiveness of infusing bupivacaine into wounds through surgical drains in reducing pain after MRM. This was a trial including a randomised control group. All patients tested negative for coronavirus disease 2019 (COVID-19) using a polymerase chain reaction (PCR) test prior to being randomly assigned to one of two groups. Group B (bupivacaine-treated patients) got 40 ml of 0.25 percent injectable bupivacaine, 20 ml into each axillary and chest wall drain, whereas Group C (control) had no instillation. The duration of analgesia was measured in hours from the time the patient was admitted to the post-anesthesia care unit after surgery until the patient experienced aching and discomfort equal to or greater than three on the visual analogue pain score chart (VAS). The mean duration of analgesia was substantially longer in Group B than in Group C (10.931.84 vs 5.031.35 hours, p=0.0005).

MRM is a treatment that entails thorough dissection of the chest wall, including the removal of the whole breast tissue, as well as the skin and nipple, as well as axillary clearing. It's unsurprising that such substantial tissue dissection results in comparable levels of intraoperative and postoperative discomfort. Numerous studies done worldwide have shown an increased necessity for opioid pain medication after mastectomy, particularly in patients who had bilateral mastectomy followed by early breast reconstructive treatments, as compared to other breast surgeries. While opioids are a great painkiller, their excessive and irrational use has a broad range of adverse consequences, from nausea to respiratory depression. Regional nerve and field blocks are an effective method of obtaining adequate analgesia after MRM, although their administration requires skill. However, the outcomes are varied and may result in iatrogenic pneumothorax during infiltration. After MRM with axillary lymph node dissection, instilling the wound with injectable bupivacaine through surgical drains provides improved postoperative pain management and reduces the need for oral and intravenous pain medication. Additionally, people function well after surgery and recover quickly postoperatively without the need of expensive medicines. As a result, this approach can be employed in MRM procedures on a regular basis.

Reference –

Shamim Seth U, Perveen S, Ahmed T, et al. (April 13, 2022) Postoperative Analgesia in Modified Radical Mastectomy Patients After Instillation of Bupivacaine Through Surgical Drains. Cureus 14(4): e24125. doi:10.7759/cureus.24125