engleski

Postoperative wound infiltration with levobupivacaine 0.5% is superior to the diclofenac 1mg/kg three times daily in the breast cancer patients

Although nonsteroidal analgesics may provide sufficient analgesia in the breast cancer patients, continuous wound infiltration may reduce breakthrough pain. We conducted this study to evaluate analgesic effects and cardiovascular stability in the breast cancer patients receiving diclofenac and wound infiltration analgesia. After the ethics committee approval was obtained, 60 patients signed their informed consent for the participation in the study. A pathohistological examination confirmed diagnosis in 51 women who were randomly assigned to the postoperative diclofenac 1 mg 3´ daily analgesia (Group diclofenac, n=25, mean age 57.6 ; body mass index 29.3) or continuous postoperative wound infiltration with levobupivacaine 0, 5% 3-5 mg/h (PCA group, n=26, mean age 55.9 ; body mass index 27.7). 1 mg bolus doses with 4 hours lockout interval were allowed. Rescue analgesics were diclofenac for VAS ≤3 and meperidine for patients having VAS ≥4. Postoperative visual analogue scale in the rest and movement, and blood pressure (BP) was registered on the postoperative (PO) day 1, 2, 3, and 4. A mean VAS in both groups was < 3 for each particular PO day. Patients in the PCA had lowerVAS scores at rest on day 1 PO (0.55 vs. 1.1), and both at rest and on movement on day 3 PO. The mean VAS scores were 0.03 and 0.8 in PCA vs. 0, 3 and 1.5 in diclofenac group (p=0.03). One patient in the diclofenac group was given blood transfusion. No other adverse events were observed in any patient. Systolic blood pressure decreased significantly in the PCA group as compared to the baseline (134.8 vs. 126 mmHg, p=0.02). Both analgesic regimens were effective and well tolerated. PCA group had lower VAS scores on 1 and 3 day PO, and statistically significant decrease in the systolic blood pressure.

wound infiltratation; levobupivacaine; diclofenac; breast cancer

DOI: d10.1097/AAP.0b013e3181f3582c