Dolor y mastectomía/Pain and mastectomy

Efecto del flurbiprofeno intravenoso sobre el dolor crónico postmastectomía


Effect of perioperative intravenous flurbiprofen axetil on chronic postmastectomy pain.
Sun M, Liao Q, Wen L, Yan X, Zhang F, Ouyang W.
Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha 410013; Department of Anesthesiology, Henan Provincial People Hospital, Zhengzhou 450000, Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2013 Jul;38(7):653-60. doi: 10.3969/j.issn.1672-7347.2013.07.001.
Abstract
Objective: To explore whether perioperative intravenous flurbiprofen axetil can reduce the incidence and intensity of chronic pain for breast cancer after surgical treatment. Methods: This randomized, double-blind, controlled trial enrolled 60 patients undergoing mastectomy and axillary lymph node dissection under general anesthesia. All patients accepted Hospital Anxiety and Depression Scale (HAD) tests the day before the surgery to evaluate depression and anxiety. The patients were randomly assigned to receive either 50 mg flurbiprofen axetil intravenously 15 minutes before the surgical incision and 6 hours later (group F) or intravenous 5 mL intralipid as a control (group C). All patients received patient-controlled intravenous analgesia (PCIA) with fentanyl postoperatively. Peripheral venous blood samples were drawn before the surgery, at 4 and 24 h after the surgery to detect the plasma level of PGE2 and tumor necrosis factor-α (TNF-α). Postoperative fentanyl consumption, Numerical Rating Scale (NRS) scores and adverse effects were recorded at 2, 6, 12, 24 and 48 h after the surgery. The duration and intensity of pain were followed up by telephone at the 2nd-12th month after the surgery. Results: The incidence of pain at 2, 4, 6, and 12 months after the breast surgery was 33%, 20%, 15%, and 10%, respectively, and the average pain score was 0.77, 0.57, 0.28, and 0.18, respectively. Compared with group C, the scores of pain in group F were significantly lower at 2, 4, 6 and 12 months postoperatively (F=7.758, P=0.007). The incidence of pain in group F was significantly lower at 2, 4 and 6 months postoperatively (P<0.05). There was no significant difference in the incidence of pain between the groups at 12 months postoperatively (P>0.05). Preoperatively and at 4 and 24 h after the surgery, there was no significant difference in the level of TNF-α between the two groups (F=0.530, P=0.470); but plasma concentration of PGE2 in group F was significantly lower than that in group C (F=5.646, P=0.021). No patients developed abnormal bleeding, peptic ulcer, impaired liver or renal function and respiratory depression. Conclusion: Perioperative intravenous infusion of 100 mg flurbiprofen axetil can decrease the intensity and incidence of chronic pain for breast cancer after surgical treatment.
http://xbyx.xysm.net/xbwk/fileup/PDF/201307653.pdf




Síndrome de dolor postmastectomía: estudio epidemiológico sobre su prevalencia
The postmastectomy pain syndrome: an epidemiological study on the prevalence of chronic pain after surgery for breast cancer.
Vilholm OJ, Cold S, Rasmussen L, Sindrup SH.
Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, Odense 5000, Denmark. Vilholm@dadlnet.dk
Br J Cancer. 2008 Aug 19;99(4):604-10. doi: 10.1038/sj.bjc.6604534.
Abstract
The prevalence of the postmastectomy pain syndrome (PMPS) and its clinical characteristics was assessed in a group of patients who had undergone surgery for breast cancer at the Department of Surgery, Odense University Hospital, within the period of 1 May 2003 to 30 April 2004. The study included 258 patients and a reference group of 774 women. A questionnaire was mailed to the patients 1 1/2 year after surgery and to the women in the reference group. The PMPS was defined as pain located in the area of the surgery or ipsilateral arm, present at least 4 days per week and with an average intensity of at least 3 on a numeric rating scale from 0 to 10. The prevalence of PMPS was found to be 23.9%. The odds ratio of developing PMPS was 2.88 (95% confidence interval 1.84-4.51). Significant risk factors were as follows: having undergone breast surgery earlier (OR 8.12), tumour located in the upper lateral quarter (OR 6.48) and young age (OR 1.04). This study shows that, although recent advances in the diagnostic and surgical procedures have reduced the frequency of the more invasive surgical procedures, there still is a considerable risk of developing PMPS after treatment of breast cancer.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2527825/pdf/6604534a.pdf



Síndrome doloroso postmastectomía: la magnitud del problema
Post-mastectomy pain syndrome: the magnitude of the problem.
Couceiro TC, Menezes TC, Valênça MM.
Responsável pela Residência Médica em Anestesiologia do Instituto de Medicina Integral Professor Fernando Figueira; Mestre em Neuropsiquiatria e Ciência do Comportamento, pela Universidade Federal de Pernambuco. taniacouceiro@yahoo.com.br
Rev Bras Anestesiol. 2009 May-Jun;59(3):358-65.
Abstract
BACKGROUND AND OBJECTIVES: Breast cancer is the most frequent neoplastic tumor in women, and surgical treatment is indicated in most patients. Complications related to this treatment, such as post-mastectomy pain syndrome (PMPS), a persistent pain that develops after surgery, have been reported. Although the genesis of the pain is multifactorial, sectioning of the intercostobrachial nerve is the nerve lesion diagnosed more often. The objective of this study was to review the etiopathogeny, diagnosis, presentation, aggravating or attenuating factors, and risk factors related with the post-mastectomy pain syndrome. CONTENTS: Provides the definition of the post-mastectomy pain syndrome and the knowledge to facilitate its diagnosis and prevention. CONCLUSIONS: The approach to patients undergoing surgery for breast cancer requires pre- and postoperative follow-up by a multidisciplinary team. This approach can provide a rational choice of surgical technique, identify patients with risk factors, minimize or eliminate risk factors whenever possible, diagnose beforehand the post-mastectomy pain syndrome, and provide adequate treatment to improve the quality of life for this specific patient population.



http://www.scielo.br/pdf/rba/v59n3/en_12.pdf



Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org