Chronic adverse effects after an axillary lymphadenectomy in breast cancer patients after administering weaker and stronger postoperative analgesia: results of a prospective double-blind randomized study.

Abstract

The aim of this study was to compare the rate of chronic adverse effects after a weaker and stronger postoperative analgesia. A prospective double-blind randomized study included 117 breast cancer patients receiving tramadol for pain relief for 4weeks after an axillary lymphadenectomy from 2015 to 2018. Patients with a larger dose received 75/650mg of tramadol with paracetamol every 8h and a group with a lower dose received 37.5/325mg of tramadol with paracetamol every 8h from the 2nd to the 29th postoperative day. 1year after surgery, patients were evaluated for the presence of neuropathic pain, chronic pain, arm symptoms and lymphedema. There was a trend for a lower rate of neuropathic pain after stronger analgesia in comparison to weaker analgesia (p = 0.059). Chronic pain was present in 18% of patients 1year after the lymphadenectomy. There was no difference in the rate of chronic pain after stronger and weaker postoperative analgesia. Patients had less arm symptoms after a stronger analgesia than after a weaker analgesia (p = 0.02). Furthermore, there was a trend for a lower rate of lymphedema of the forearm after a stronger analgesia than after a lower analgesia (p = 0.078). The patients who received a stronger postoperative analgesia had less arm symptoms and a better quality of life in comparison to patients who received a weaker analgesia. The patients who received a stronger postoperative analgesia had a statistical trend for less neuropathic pain in comparison to patients who received a weaker analgesia.