Persistent postdischarge pain and chronic postoperative pain after breast cancer surgery under general anesthesia and single-shot paravertebral block: incidence, characteristics and impact on quality of life and healthcare costs.

Andrea Saporito,Roberto Poggi,Davide La Regina,Samuele Ceruti,Bruno Minotti,Alain Borgeat,Stefano Cafarotti,Andreas Perren,Luciano Anselmi,José Aguirre

doi:10.2147/jpr.s195702

Abstract

Introduction: Breast surgery is associated with persistent postsurgical pain; usually related to poorly treated acute pain. Paravertebral block has been successfully employed in analgesic protocols for breast surgery; its impact on postdischarge pain (PDP) has not been investigated. The aim of this study was to assess characteristics of PDP after breast surgery, the development of chronic postoperative pain (CPP) and its impact on health care costs.Methods: We conducted a retrospective, observational study on a continuous cohort of adult female patients undergoing local breast cancer surgery under combined anesthesia. All patients were interviewed 6 months after hospital discharge. The survey was specifically conceived to assess incidence, features and duration of PDP. The overall cost of additional healthcare resources consumed with a specific relationship to persistent PDP was estimated.Results: A database of 244 patients was preliminarily analyzed. Of these, 188 were included in the following statistical analysis; 123 patients (65.2%) reported significant PDP, with a median intensity on NRS of 6 (IQR=2), more frequently described as burning and associated with paresthesia and/or hyperalgesia (87 patients, 46%). One hundred and six patients (56.5%) reported this pain as interfering with their normal daily activities, work and sleep. In 26.8% of cases (50 patients) symptoms lasted more than 1 month and in 28 patients (15.0%) pain became chronic. The majority of patients self-treated their pain with non-steroideal anti-inflammatory drugs, but in 50 patients (26.8%) this therapy was reported as ineffective. This additional consumption of healthcare resources led to a significant economical impact.Conclusion: PDP and CPP seem to be common complications after breast cancer surgery, even if a combined anesthesia technique with a thoracic paravertebral block is performed, leading to severe consequences on patients’ quality of life and increasing consumption of healthcare resources after discharge.Trial number: NCT03618459 (www.clinicaltrials.gov).

Highlights

Breast surgery is associated with persistent postsurgical pain; usually related to poorly treated acute pain
Paravertebral block has been successfully employed in analgesic protocols for breast surgery; its impact on postdischarge pain (PDP) has not been investigated
Breast surgery is associated with a high prevalence of chronic postoperative pain (CPP).[2]

Summary

Introduction

Breast surgery is associated with persistent postsurgical pain; usually related to poorly treated acute pain. The majority of patients self-treated their pain with non-steroideal anti-inflammatory drugs, but in 50 patients (26.8%) this therapy was reported as ineffective This additional consumption of health care resources led to a significant economical impact. Breast surgery is associated with a high prevalence of chronic postoperative pain (CPP).[2] Patients complain about persistent painful sensation in correspondence of the surgical wound, lasting beyond 2 months since the surgical intervention. This has progressively emerged as a relatively frequent delayed complication of breast surgery, being its prevalence of up to 60%.2. This has progressively emerged as a relatively frequent delayed complication of breast surgery, being its prevalence of up to 60%.2 this disabling condition significantly affects cancer survivors’ quality of life[3,4] and to have an impact on healthcare costs.[5,6]

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