A prospective randomized controlled trial to compare the efficacy of wound instillation with 0.25% bupivacaine, 0.2% ropivacaine and normal saline for postoperative analgesia in breast surgery

Abstract

Modified Radical Mastectomy (MRM) is the commonly used surgical procedure for operable breast cancer, which involves extensive tissue dissection.We hypothesized that instillation of 0.25% bupivacaine and 0.2% ropivacaine through chest and axillary drains into the wound may provide postoperative analgesia, even better than infiltration along the line of incision. In this prospective randomized controlled study 68 patients aged more than 18 years were divided into four groups. All patients were administered general anesthesia. At the end of the procedure, axillary and chest drains were placed before closure. Group C was the control group with no instillation, group B received 40 ml 0.25% bupivacaine, group R received 40 ml 0.2% ropivacaine and group S received 40 ml normal saline (20ml through each drain) and the drains were clamped for 10 mins. After extubation, pain score was evaluated using Visual Analogue Scale (VAS) at rest, cough and overhead abduction of the arm at 0,1,2,3,4,8,12 and 24 hours. Rescue analgesia was injection tramadol, given if the pain score ≥ 3. Statistical analysis was performed using SPSS version 21. There was a significant difference in the cumulative analgesic requirement and the number of analgesic demands between the groups (p<0.001). The mean duration of analgesia in the ropivacaine, bupivacaine, saline group and the control group were 10.64 hours, 10.07 hours, 7.49 hours and 2.3 hours respectively. Wound instillation with local anesthetics is a simple and effective means of providing good analgesia without any major side effects.