engleski

Efficacy of perioperative intravenous lidocaine on reducing chronic postsurgical pain after breast cancer surgery

Background and purpose:Chronic postsurgical pain (CPSP) occurs in approximately 10% of surgical patients and is a common complication after breast cancer surgery. Research on prevention of CPSP suggests that the perioperative use of intravenous lidocaine may decrease the incidence of CPSP three and six months after breast surgery. Materials and methods: We investigated the results from controlled randomised trials in the last five years. These trials included 514 patients and assessed the incidence of CPSP after breast cancer surgery in women receiving intravenous lidocaine or placebo. Patients were randomized into two groups ; lidocaine (1.5 mg/kg bolus of intravenous lidocaine followed by 2mg/kg/hr infusion) or control group (saline). One recent pilot study tested further subcutaneous administration of lidocaine postoperatively for up to 12h (1, 33mg/kg/h). In the trials different tools for pain scoring were used, for instance Numerical Rating Scale (rest/movement ), yes/no scoring, Brief Pain Inventory, Neuropathic Pain Questionnaire, SF-MPQ- II. Results: After three months, more than half of the patients reported CPSP. Lidocaine decreased the development of CPSP (63% vs 43, 1%). The incidence of any pain or discomfort related to the surgical wound was lower in the lidocaine group than with placebo: 20% vs. 25% at 3 months, and 27% vs. 30% at 6 months, while moderate or severe CPSP was not significally reduced: 13% vs. 9% at 3 months and 12% vs. 12% at 6 months. Patients with moderate or severe CPSP reported severer neuropathic disorders than those with mild CPSP. One study showed reduction of pain at rest at 6 months in the lidocaine group vs placebo. Conclusions: Analyzing clinical trials, we conclude that intravenous perioperative lidocaine affects the development of CPSP after breast cancer surgery. Lidocaine has a positive impact on acute postoperative recovery, therefore surely preventing CPSP. More data by testing preventive administration of lidocaine alone or as a part of multimodal analgesia during and after breast cancer surgery should be collected. To evaluate CPSP by intensity, pain character and life quality modified neuropathic pain scales could be used.

chronic postsurgical pain ; lidocaine infusion ; breast cancer surgery

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