Does the perioperative analgesic/anesthetic regimen influence the prevalence of long-term chronic pain after mastectomy?

Arnaud Steyaert (Corresponding Author), Patrice Forget, Virginie Dubois, Patricia Lavand'homme, Marc De Kock

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Study Objective
To investigate if the anesthetic/analgesic regimen is associated with the risk of reporting long-term chronic postmastectomy pain (CPMP).

Design
Cross-sectional survey

Setting
Academic hospital

Patients
A total of 267 women having undergone mastectomy with axillary lymph node dissection between 2003 and 2008

Interventions
All patients were contacted between October and December 2012, with a questionnaire asking for persistent pain after surgery and its characteristics.

Measurements
Besides demographical data, tumor characteristics, and adjuvant treatment, we recorded type and doses of intraoperative anesthetics/analgesics (sufentanil, ketamine, clonidine, nonsteroidal anti-inflammatory drugs, MgSO4, propofol, or halogenated agents).

Results
Of the 128 patients returning analyzable questionnaires, 43.8% reported chronic pain (48.2% with neuropathic characteristics). Multivariate logistic/linear regression model showed 4 factors independently associated with persistent pain: recall of preoperative pain (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.09-1.48), chemotherapy (OR, 1.32; 95% CI, 1.13-1.55), need for strong opioids in postanesthesia care unit (OR, 1.30; 95% CI, 1.11-1.53), and halogenated agent anesthesia (OR, 0.81; 95% CI, 0.70-0.95).

Conclusion
In conclusion, our study confirms the high prevalence of CPMP, 4 to 9 years after surgery. Recall of preoperative pain, chemotherapy, and need for strong opioids in the postanesthesia care unit were all associated with the presence of chronic pain. Of the intraoperative analgesics/anesthetics studied, only use of halogenated agents was associated with a lower prevalence of CPMP.
Original languageEnglish
Pages (from-to)20-25
Number of pages6
JournalJournal of Clinical Anesthesia
Volume33
Early online date6 Apr 2016
DOIs
Publication statusPublished - Sep 2016

Fingerprint

Mastectomy
Chronic Pain
Analgesics
Anesthetics
Odds Ratio
Confidence Intervals
Pain
Opioid Analgesics
Linear Models
Sufentanil
Drug Therapy
Ketamine
Clonidine
Propofol
Lymph Node Excision
Anti-Inflammatory Agents
Anesthesia
Logistic Models
Pharmaceutical Preparations
Neoplasms

Keywords

  • chronic postsurgical pain
  • Chronic postmastectomy pain
  • postoperative pain
  • breast cancer

Cite this

Does the perioperative analgesic/anesthetic regimen influence the prevalence of long-term chronic pain after mastectomy? / Steyaert, Arnaud (Corresponding Author); Forget, Patrice; Dubois, Virginie; Lavand'homme, Patricia; De Kock, Marc.

In: Journal of Clinical Anesthesia, Vol. 33, 09.2016, p. 20-25.

Research output: Contribution to journalArticle

Steyaert, Arnaud ; Forget, Patrice ; Dubois, Virginie ; Lavand'homme, Patricia ; De Kock, Marc. / Does the perioperative analgesic/anesthetic regimen influence the prevalence of long-term chronic pain after mastectomy?. In: Journal of Clinical Anesthesia. 2016 ; Vol. 33. pp. 20-25.
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title = "Does the perioperative analgesic/anesthetic regimen influence the prevalence of long-term chronic pain after mastectomy?",
abstract = "Study ObjectiveTo investigate if the anesthetic/analgesic regimen is associated with the risk of reporting long-term chronic postmastectomy pain (CPMP).DesignCross-sectional surveySettingAcademic hospitalPatientsA total of 267 women having undergone mastectomy with axillary lymph node dissection between 2003 and 2008InterventionsAll patients were contacted between October and December 2012, with a questionnaire asking for persistent pain after surgery and its characteristics.MeasurementsBesides demographical data, tumor characteristics, and adjuvant treatment, we recorded type and doses of intraoperative anesthetics/analgesics (sufentanil, ketamine, clonidine, nonsteroidal anti-inflammatory drugs, MgSO4, propofol, or halogenated agents).ResultsOf the 128 patients returning analyzable questionnaires, 43.8{\%} reported chronic pain (48.2{\%} with neuropathic characteristics). Multivariate logistic/linear regression model showed 4 factors independently associated with persistent pain: recall of preoperative pain (odds ratio [OR], 1.27; 95{\%} confidence interval [CI], 1.09-1.48), chemotherapy (OR, 1.32; 95{\%} CI, 1.13-1.55), need for strong opioids in postanesthesia care unit (OR, 1.30; 95{\%} CI, 1.11-1.53), and halogenated agent anesthesia (OR, 0.81; 95{\%} CI, 0.70-0.95).ConclusionIn conclusion, our study confirms the high prevalence of CPMP, 4 to 9 years after surgery. Recall of preoperative pain, chemotherapy, and need for strong opioids in the postanesthesia care unit were all associated with the presence of chronic pain. Of the intraoperative analgesics/anesthetics studied, only use of halogenated agents was associated with a lower prevalence of CPMP.",
keywords = "chronic postsurgical pain, Chronic postmastectomy pain, postoperative pain, breast cancer",
author = "Arnaud Steyaert and Patrice Forget and Virginie Dubois and Patricia Lavand'homme and {De Kock}, Marc",
note = "The authors would like to thank Pr. Martine Berli{\`e}re (surgeon, department of Gynecology, Cliniques Universitaires Saint-Luc, Universit{\'e} Catholique de Louvain) for her support during this study.",
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AU - Dubois, Virginie

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AU - De Kock, Marc

N1 - The authors would like to thank Pr. Martine Berlière (surgeon, department of Gynecology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain) for her support during this study.

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N2 - Study ObjectiveTo investigate if the anesthetic/analgesic regimen is associated with the risk of reporting long-term chronic postmastectomy pain (CPMP).DesignCross-sectional surveySettingAcademic hospitalPatientsA total of 267 women having undergone mastectomy with axillary lymph node dissection between 2003 and 2008InterventionsAll patients were contacted between October and December 2012, with a questionnaire asking for persistent pain after surgery and its characteristics.MeasurementsBesides demographical data, tumor characteristics, and adjuvant treatment, we recorded type and doses of intraoperative anesthetics/analgesics (sufentanil, ketamine, clonidine, nonsteroidal anti-inflammatory drugs, MgSO4, propofol, or halogenated agents).ResultsOf the 128 patients returning analyzable questionnaires, 43.8% reported chronic pain (48.2% with neuropathic characteristics). Multivariate logistic/linear regression model showed 4 factors independently associated with persistent pain: recall of preoperative pain (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.09-1.48), chemotherapy (OR, 1.32; 95% CI, 1.13-1.55), need for strong opioids in postanesthesia care unit (OR, 1.30; 95% CI, 1.11-1.53), and halogenated agent anesthesia (OR, 0.81; 95% CI, 0.70-0.95).ConclusionIn conclusion, our study confirms the high prevalence of CPMP, 4 to 9 years after surgery. Recall of preoperative pain, chemotherapy, and need for strong opioids in the postanesthesia care unit were all associated with the presence of chronic pain. Of the intraoperative analgesics/anesthetics studied, only use of halogenated agents was associated with a lower prevalence of CPMP.

AB - Study ObjectiveTo investigate if the anesthetic/analgesic regimen is associated with the risk of reporting long-term chronic postmastectomy pain (CPMP).DesignCross-sectional surveySettingAcademic hospitalPatientsA total of 267 women having undergone mastectomy with axillary lymph node dissection between 2003 and 2008InterventionsAll patients were contacted between October and December 2012, with a questionnaire asking for persistent pain after surgery and its characteristics.MeasurementsBesides demographical data, tumor characteristics, and adjuvant treatment, we recorded type and doses of intraoperative anesthetics/analgesics (sufentanil, ketamine, clonidine, nonsteroidal anti-inflammatory drugs, MgSO4, propofol, or halogenated agents).ResultsOf the 128 patients returning analyzable questionnaires, 43.8% reported chronic pain (48.2% with neuropathic characteristics). Multivariate logistic/linear regression model showed 4 factors independently associated with persistent pain: recall of preoperative pain (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.09-1.48), chemotherapy (OR, 1.32; 95% CI, 1.13-1.55), need for strong opioids in postanesthesia care unit (OR, 1.30; 95% CI, 1.11-1.53), and halogenated agent anesthesia (OR, 0.81; 95% CI, 0.70-0.95).ConclusionIn conclusion, our study confirms the high prevalence of CPMP, 4 to 9 years after surgery. Recall of preoperative pain, chemotherapy, and need for strong opioids in the postanesthesia care unit were all associated with the presence of chronic pain. Of the intraoperative analgesics/anesthetics studied, only use of halogenated agents was associated with a lower prevalence of CPMP.

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