Analgesic and Sensory Effects of the Pecs Local Anesthetic Block in Patients with Persistent Pain after Breast Cancer Surgery: A Pilot Study

Pain Practice ◽  
2016 ◽  
Vol 17 (2) ◽  
pp. 185-191 ◽  
Author(s):  
Nelun Wijayasinghe ◽  
Kenneth G. Andersen ◽  
Henrik Kehlet
Keyword(s):  
Breast Cancer ◽  
Pilot Study ◽  
Local Anesthetic ◽  
Persistent Pain ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Sensory Effects

scholarly journals Ultrasound Guided Intercostobrachial Nerve Blockade in Patients with Persistent Pain after Breast Cancer Surgery: A Pilot Study

2016 ◽  
Vol 19 (2;2) ◽  
pp. E309-E317 ◽  
Author(s):  
Nelun Wijayasinghe
Keyword(s):  
Breast Cancer ◽  
Pilot Study ◽  
Ultrasound Guidance ◽  
Persistent Pain ◽  
Cancer Surgery ◽  
Sensory Function ◽  
Breast Cancer Surgery ◽  
Maximum Point ◽  
Ultrasound Guided ◽  
Intercostobrachial Nerve

Background: Persistent pain after breast cancer surgery (PPBCS) affects 25 – 60% of breast cancer survivors and damage to the intercostobrachial nerve (ICBN) has been implicated as the cause of this predominantly neuropathic pain. Local anesthetic blockade of the ICBN could provide clues to pathophysiological mechanisms as well as aiding diagnosis and treatment of PPBCS but has never been attempted. Objectives: To assess the feasibility of ICBN blockade and assess its effects on pain and sensory function in patients with PPBCS. Study Design: This prospective pilot study was performed in 2 parts: Part 1 determined the sonoanatomy of the ICBN and part 2 examined effects of the ultrasound-guided ICBN blockade in patients with PPBCS. Setting: Section for Surgical Pathophysiology at Rigshospitalet, Copenhagen, Denmark. Methods: Part 1: Sixteen unoperated, pain free breast cancer patients underwent systematic ultrasonography to establish the sonoanatomy of the ICBN. Part 2: Six patients with PPBCS who had pain in the axilla and upper arm were recruited for the study. Summed pain intensity (SPI) scores and sensory function were measured before and 30 minutes after the block was administered. SPI is a combined pain score of numerical rating scale (NRS) at rest, movement, and 100kPa pressure applied to the maximum point of pain using pressure algometry (max = 30). Sensory function was measured using quantitative sensory testing, which consisted of sensory mapping, thermal thresholds, suprathreshold heat pain perception as well as heat and pressure pain thresholds. The ICBN block was performed under ultrasound guidance and 10 mL 0.5% bupivacaine was injected. Outcome Assessment: The ability to perform the ICBN block and its analgesic and sensory effects. Results: Only the second intercostal space could be seen on ultrasound which was adequate to perform the ICBN block. The mean difference in SPI was -9 NRS points (95%CI: -14.1 to -3.9), P = 0.006. All patients had pre-existing areas of hypoesthesia which decreased in size in 4/6 patients after the block. Limitations: The main limitation of this pilot study is its small sample size, but despite this, a statistically significant effect was observed. Conclusion: We have successfully managed to block the ICBN using ultrasound guidance and demonstrated an analgesic effect in patients in PPBCS calling for placebo-controlled studies. Key words: Anesthesia, local; intercostobrachial nerve; mastectomy; nerve block; neuralgia

scholarly journals Development of a screening instrument for risk factors of persistent pain after breast cancer surgery

2012 ◽  
Vol 107 (9) ◽  
pp. 1459-1466 ◽  
Author(s):  
R Sipilä ◽  
A-M Estlander ◽  
T Tasmuth ◽  
M Kataja ◽  
E Kalso
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Screening Instrument ◽  
Persistent Pain ◽  
Cancer Surgery ◽  
Breast Cancer Surgery

scholarly journals Hyperalgesia and Persistent Pain after Breast Cancer Surgery: A Prospective Randomized Controlled Trial with Perioperative COX-2 Inhibition

PLoS ONE ◽  
2016 ◽  
Vol 11 (12) ◽  
pp. e0166601 ◽  
Author(s):  
Noud van Helmond ◽  
Monique A. Steegers ◽  
Gertie P. Filippini-de Moor ◽  
Kris C. Vissers ◽  
Oliver H. Wilder-Smith
Keyword(s):  
Breast Cancer ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Persistent Pain ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial ◽  
Cox 2

Clinical Prediction Model and Tool for Assessing Risk of Persistent Pain After Breast Cancer Surgery

2017 ◽  
Vol 35 (15) ◽  
pp. 1660-1667 ◽  
Author(s):  
Tuomo J. Meretoja ◽  
Kenneth Geving Andersen ◽  
Julie Bruce ◽  
Lassi Haasio ◽  
Reetta Sipilä ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Prediction Model ◽  
Prediction Models ◽  
Persistent Pain ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Outcome Variable ◽  
Axillary Lymph ◽  
Operating Characteristics

Purpose Persistent pain after breast cancer surgery is a well-recognized problem, with moderate to severe pain affecting 15% to 20% of women at 1 year from surgery. Several risk factors for persistent pain have been recognized, but tools to identify high-risk patients and preventive interventions are missing. The aim was to develop a clinically applicable risk prediction tool. Methods The prediction models were developed and tested using three prospective data sets from Finland (n = 860), Denmark (n = 453), and Scotland (n = 231). Prediction models for persistent pain of moderate to severe intensity at 1 year postoperatively were developed by logistic regression analyses in the Finnish patient cohort. The models were tested in two independent cohorts from Denmark and Scotland by assessing the areas under the receiver operating characteristics curves (ROC-AUCs). The outcome variable was moderate to severe persistent pain at 1 year from surgery in the Finnish and Danish cohorts and at 9 months in the Scottish cohort. Results Moderate to severe persistent pain occurred in 13.5%, 13.9%, and 20.3% of the patients in the three studies, respectively. Preoperative pain in the operative area ( P < .001), high body mass index ( P = .039), axillary lymph node dissection ( P = .008), and more severe acute postoperative pain intensity at the seventh postoperative day ( P = .003) predicted persistent pain in the final prediction model, which performed well in the Danish (ROC-AUC, 0.739) and Scottish (ROC-AUC, 0.740) cohorts. At the 20% risk level, the model had 32.8% and 47.4% sensitivity and 94.4% and 82.4% specificity in the Danish and Scottish cohorts, respectively. Conclusion Our validated prediction models and an online risk calculator provide clinicians and researchers with a simple tool to screen for patients at high risk of developing persistent pain after breast cancer surgery.

scholarly journals Persistent Pain After Breast Cancer Surgery

Pain Medicine ◽  
2007 ◽  
Vol 8 (7) ◽  
pp. 611.1-611 ◽  
Author(s):  
B Lau ◽  
F Blyth ◽  
M Cousins
Keyword(s):  
Breast Cancer ◽  
Persistent Pain ◽  
Cancer Surgery ◽  
Breast Cancer Surgery
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