scholarly journals Can Acute Pain Treatment Reduce Postsurgical Comorbidity after Breast Cancer Surgery? A Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Fumimasa Amaya ◽  
Toyoshi Hosokawa ◽  
Akiko Okamoto ◽  
Megumi Matsuda ◽  
Yosuke Yamaguchi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Acute Pain ◽  
Pain Treatment ◽  
Cancer Recurrence ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Regional Analgesia ◽  
Postsurgical Pain ◽  
Analgesic Regimen ◽  
Definition Of

Regional analgesia, opioids, and several oral analgesics are commonly used for the treatment of acute pain after breast cancer surgery. While all of these treatments can suppress the acute postsurgical pain, there is growing evidence that suggests that the postsurgical comorbidity will differ in accordance with the type of analgesic used during the surgery. Our current study reviewed the effect of analgesics used for acute pain treatments on the major comorbidities that occur after breast cancer surgery. A considerable number of clinical studies have been performed to investigate the relationship between the acute analgesic regimen and common comorbidities, including inadequate quality of recovery after the surgery, persistent postsurgical pain, and cancer recurrence. Previous studies have shown that the choice of the analgesic modality does affect the postsurgical comorbidity. In general, the use of regional analgesics has a beneficial effect on the occurrence of comorbidity. In order to determine the best analgesic choice after breast cancer surgery, prospective studies that are based on a clear definition of the comorbidity state will need to be undertaken in the future.

scholarly journals Predictive Factors for Patients who Need Treatment for Chronic Post-Surgical Pain (CPSP) after Breast Cancer Surgery

2021 ◽  
Author(s):  
Yasuaki Uemoto ◽  
Megumi Uchida ◽  
Naoto Kondo ◽  
Yumi Wanifuchi-Endo ◽  
Takashi Fujita ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Recurrence ◽  
Japanese Version ◽  
Cancer Surgery ◽  
Breast Cancer Recurrence ◽  
Breast Cancer Surgery ◽  
Cross Sectional ◽  
Postsurgical Pain ◽  
Post Surgery ◽  
Chronic Postsurgical Pain

Abstract Purpose: Although chronic postsurgical pain (CPSP) after breast cancer surgery is a common and prevalent postsurgical adverse event, the need for CPSP treatment has not been investigated. This study examined the proportion of patients who needed treatment for CPSP and associated predictors. Methods: We conducted a cross-sectional study with female patients who underwent breast cancer surgery at our institution. Participants were aged ≤65 years at the time of this study and were at least 1 year post surgery. The questionnaire examined the presence of and need for treatment for CPSP and included the Japanese version of the Concerns about Recurrence Scale (CARS-J). Multivariate analyses were used to identify independent predictors of needing treatment for CPSP.Results: In total, 305 patients completed the questionnaire. The mean time since surgery was 67.1 months; 151 (51%) patients developed CPSP after breast cancer surgery and 61 (39%) needed treatment for CPSP. Among patients that developed CPSP, the fear of breast cancer recurrence as assessed by the CARS-J (odds ratio [OR] 2.22, 95% confidence interval [CI]: 1.30–3.81, P=0.004) and >2 postsurgical pain regions (OR 2.52, 95% CI: 1.16–5.57, P=0.020) were independent predictors of needing treatment for CPSP.Conclusions: This study is the first to identify the proportion and predictors of patients who need treatment for CPSP. Fear of breast cancer recurrence and >2 postsurgical pain regions may predict the need for CPSP treatment among patients following breast cancer surgery.

scholarly journals Can Anesthetic Technique for Primary Breast Cancer Surgery Affect Recurrence or Metastasis?

2006 ◽  
Vol 105 (4) ◽  
pp. 660-664 ◽  
Author(s):  
Aristomenis K. Exadaktylos ◽  
Donal J. Buggy ◽  
Denis C. Moriarty ◽  
Edward Mascha ◽  
Daniel I. Sessler
Keyword(s):  
Breast Cancer ◽  
General Anesthesia ◽  
Surgical Stress ◽  
Cancer Recurrence ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Anesthetic Technique ◽  
Morphine Analgesia ◽  
Regional Analgesia

Background Regional anesthesia is known to prevent or attenuate the surgical stress response; therefore, inhibiting surgical stress by paravertebral anesthesia might attenuate perioperative factors that enhance tumor growth and spread. The authors hypothesized that breast cancer patients undergoing surgery with paravertebral anesthesia and analgesia combined with general anesthesia have a lower incidence of cancer recurrence or metastases than patients undergoing surgery with general anesthesia and patient-controlled morphine analgesia. Methods In this retrospective study, the authors examined the medical records of 129 consecutive patients undergoing mastectomy and axillary clearance for breast cancer between September 2001 and December 2002. Results Fifty patients had surgery with paravertebral anesthesia and analgesia combined with general anesthesia, and 79 patients had general anesthesia combined with postoperative morphine analgesia. The follow-up time was 32 +/- 5 months (mean +/- SD). There were no significant differences in patients or surgical details, tumor presentation, or prognostic factors. Recurrence- and metastasis-free survival was 94% (95% confidence interval, 87-100%) and 82% (74-91%) at 24 months and 94% (87-100%) and 77% (68-87%) at 36 months in the paravertebral and general anesthesia patients, respectively (P = 0.012). Conclusions This retrospective analysis suggests that paravertebral anesthesia and analgesia for breast cancer surgery reduces the risk of recurrence or metastasis during the initial years of follow-up. Prospective trials evaluating the effects of regional analgesia and morphine sparing on cancer recurrence seem warranted.

scholarly journals Effects of Intraoperative Low-Dose Ketamine on Persistent Postsurgical Pain after Breast Cancer Surgery: A Prospective, Randomized, Controlled, Double-Blind Study

2020 ◽  
Vol 1;23 (1;1) ◽  
pp. 37-47
Author(s):  
Ah-Reum Cho
Keyword(s):  
Breast Cancer ◽  
Study Design ◽  
Low Dose ◽  
Rating Scale ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Control Group ◽  
Double Blind Study ◽  
Postsurgical Pain ◽  
Number Of Patients

Background: Compared to acute postsurgical pain, studies regarding the role of ketamine in persistent postsurgical pain (PPSP) are limited. Objectives: The aim of this clinical trial was to test if intraoperative low-dose ketamine without postoperative infusion would reduce PPSP development after breast cancer surgery. Study design: We used a randomized, double-blinded, placebo study design. Setting: This study was conducted at Pusan National University Hospital, Republic of Korea, between December 2013 and August 2016. Methods: A total of 184 patients scheduled for breast cancer surgery were randomly assigned to either the control or ketamine group. Before skin incision, a bolus (0.5 mg/kg of ketamine or placebo), followed by a continuous infusion (0.12 mg/kg/h of ketamine or placebo), was administered until the end of the surgery. The patients were interviewed via telephone 1, 3, and 6 months after surgery. The first question was whether the patient had surgery-related pain. If answered affirmatively, questions from the Numeric Rating Scale for pain at rest (NRSr) and for coughing (NRSd) were also asked. Our primary outcome was the incidence of PPSP at 3 months after surgery. Results: For PPSP analysis, 168 patients were included. The number of patients who experienced pain was significantly lower in the ketamine group at 3 months (86.9% in the control group vs 69.0% in the ketamine group, P = .005) postoperatively. However, the NRSr and NRSd did not differ between the groups throughout the follow-up. Limitations: There were no postoperative low-dose ketamine infusion groups to compare due to hospital regulations. Dosage of ketamine was too low to reduce the severity of PPSP. And by using propofol and remifentanil for anesthesia, different results can be deduced with volatile anesthetics. Data from written questionnaires would have been more specific than telephone interviews for long-term assessment. Conclusions: Though intraoperative low-dose ketamine without postoperative infusion significantly reduced the incidence of PPSP up to 3 months after breast cancer surgery, it failed to reduce clinically significant PPSP and improve patients’ quality of life. Key words: Analgesia, breast cancer, chronic pain, ketamine, mastectomy, morphine, pain, postoperative, propofol

Genetic variability of tramadol pharmacokinetic genes and pain treatment outcome after breast cancer surgery.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23133-e23133
Author(s):  
Nikola Besic ◽  
Katja Goricar ◽  
Jakob Jeriha ◽  
Vita Dolzan ◽  
Branka Strazisar
Keyword(s):  
Breast Cancer ◽  
Genetic Variability ◽  
Cancer Patients ◽  
Pain Treatment ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Node Dissection ◽  
One Year

e23133 Background: Tramadol is a treatment of choice for pain management after axillary lymph node dissection in breast cancer patients. Tramadol is metabolized via CYP2D6 and UGT2B7, while ABCB1, ABCC2 and SLC22A1 are involved in transport of tramadol metabolites. Genetic variability of metabolizing enzymes or drug transporters may therefore affect efficacy and adverse effects of tramadol. The aim of this study was to evaluate the association of genetic variability in tramadol pharmacokinetics pathway on long-term outcome of tramadol pain treatment after breast cancer surgery. Methods: The study included 102 breast cancer patients treated with either 75 or 37.5 mg of tramadol for pain relief after breast cancer surgery including axillary lymph node dissection as part of a randomized clinical trial KCT 04/2015-DORETAonko/si at Institute of Oncology Ljubljana. All patients were genotyped for 14 polymorphisms in ABCB1, ABCC2, CYP2D6, SLC22A1 and UGT2B7 genes, as well as for CYP2D6 duplication and deletion. CYP2D6 phenotype was predicted from the genotype data and patients were categorized as poor (PM), intermediate, extensive or ultrarapid metabolizers. The association of genetic factors with pain one year after treatment was evaluated using logistic regression and Mann-Whitney test. Results: One year after treatment, 21 (20.8%) patients were still experiencing chronic and 25 (24.8%) neuropathic pain. CYP2D6 PMs were significantly more likely to experience chronic and neuropathic pain after tramadol treatment (OR = 5.96, 95% CI = 1.22-29.13, p = 0.027 and OR = 9.31, 95% CI = 1.65-50.59, p = 0.011, respectively), even after adjustment for tramadol dose (p = 0.032 and p = 0.016, respectively). PMs also had higher average pain intensity compared to others regardless of tramadol dose (p = 0.042). In patients receiving lower tramadol dose, ABCB1 rs1128503, rs2032582 and rs1045642 were associated with more chronic pain in the dominant model (p = 0.004, p = 0.004 and p = 0.047, respectively). Conclusions: Genetic variability in tramadol pharmacokinetics pathway may be associated with pain treatment outcome in breast cancer patients, therefore pharmacogenetic testing could enable more effective tramadol treatment. Clinical trial information: EudraCT 2015-000992-28.

scholarly journals Total Intravenous Anesthesia versus Inhalation Anesthesia for Breast Cancer Surgery

2019 ◽  
Vol 130 (1) ◽  
pp. 31-40 ◽  
Author(s):  
Seokha Yoo ◽  
Han-Byoel Lee ◽  
Wonshik Han ◽  
Dong-Young Noh ◽  
Sun-Kyung Park ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Retrospective Cohort ◽  
Cancer Recurrence ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Recurrence Free Survival ◽  
Inhalation Anesthesia ◽  
Free Survival ◽  
Volatile Anesthesia

Abstract EDITOR’S PERSPECTIVE What We Know about This Topic IV anesthesia may impair anticancer immunity less than volatile anesthesia and therefore reduce recurrence risk What This Article Tells Us That Is New In a large propensity-matched retrospective cohort analysis, the authors compared total IV and volatile anesthesia for breast cancer surgery Recurrence hazard was similar with each approach Selection of IV or volatile anesthesia should be based on factors other than cancer recurrence Background The association between type of anesthesia used and recurrence of cancer remains controversial. This retrospective cohort study compared the influence of total IV anesthesia and inhalation anesthesia on the primary outcome of recurrence-free survival after breast cancer surgery. Methods The authors reviewed the electronic medical records of patients who had breast cancer surgery at a tertiary care teaching hospital between January 2005 and December 2013. The patients were grouped according to whether IV or inhalation anesthesia was used for surgery. Propensity score matching was used to account for differences in baseline characteristics. Kaplan–Meier survival curves were constructed to evaluate the influence of type of anesthesia on recurrence-free survival and overall survival. The risks of cancer recurrence and all-cause mortality were compared between each type of anesthesia. Results Of 7,678 patients who had breast cancer surgery during the study period, data for 5,331 patients were available for analysis (IV group, n = 3,085; inhalation group, n = 2,246). After propensity score matching, 1,766 patients remained in each group. Kaplan–Meier survival curves showed that there was no significant difference in recurrence-free survival or overall survival between the two groups, with 5-yr recurrence-free survival rates of 93.2% (95% CI, 91.9 to 94.5) in the IV group and 93.8% (95% CI, 92.6 to 95.1) in the inhalation group. Inhalation anesthesia had no significant impact on recurrence-free survival (hazard ratio, 0.96; 95% CI, 0.69 to 1.32; P = 0.782) or overall survival (hazard ratio, 0.96; 95% CI, 0.69 to 1.33, P = 0.805) when compared with total IV anesthesia. Conclusions The authors found no association between type of anesthesia used and the long-term prognosis of breast cancer. The results of this retrospective cohort study do not suggest specific selection of IV or inhalation anesthesia for breast cancer surgery.

scholarly journals Paravertebral block for the prevention of chronic postsurgical pain after breast cancer surgery

2021 ◽  
pp. rapm-2020-102040
Author(s):  
Hakim Harkouk ◽  
Dominique Fletcher ◽  
Valeria Martinez
Keyword(s):  
Breast Cancer ◽  
Cancer Surgery ◽  
Paravertebral Block ◽  
Grade System ◽  
Breast Cancer Surgery ◽  
Quality Of Evidence ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain ◽  
Time Point

Patients frequently report chronic postsurgical pain (CPSP) after breast cancer surgery (BCS). The paravertebral block (PVB) is an effective technique to reduce acute postoperative pain after BCS, but its efficacy in preventing CPSP is unclear. This meta-analysis evaluates the efficacy of PVB in preventing CPSP after BCS. We searched Medline, Embase, CENTRAL, Database of Abstracts of Reviews of Effects, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform for studies comparing PVB with control for CPSP prevention after BCS, from inception to April 2020. The primary outcome was CPSP at 6 months, and the secondary outcomes were CPSP at 3 and 12 months, chronic postsurgical neuropathic pain (CPSNP) at 6 months, and PVB-related complications. Data were pooled and analyzed with a random-effects model, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to evaluate the certainty of evidence. A total of 12 studies were included in the study; data for the 6-month time point from 7 studies (2161 patients) were analyzed, and no difference was found between PVB and control in terms of efficacy in preventing CPSP after BCS (risk ratio (RR) 0.82 (95% CI 0.62 to 1.08)), with a moderate quality of evidence according to the GRADE system. Similar results were obtained at 3 and 12 months (RR 0.78 (95% CI 0.57 to 1.06), RR 0.45 (95% CI 0.14 to 1.41), respectively). Data for the 12-month time point from seven studies (2087 patients) were analyzed and showed that PVB protected against CPSNP, with low quality of evidence (RR 0.51 (95% CI 0.31 to 0.85)). In conclusion, CPSP was not found significantly prevented by PVB after BCS despite the limits in the included studies; nevertheless, PVB could prevent CPSNP by impacting the transition from acute to chronic pain.

Risk factors for acute pain and its persistence following breast cancer surgery

Pain ◽  
2005 ◽  
Vol 119 (1-3) ◽  
pp. 16-25 ◽  
Author(s):  
Jennifer Katz ◽  
Ellen L. Poleshuck ◽  
Carl H. Andrus ◽  
Laura A. Hogan ◽  
Beth F. Jung ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Acute Pain ◽  
Cancer Surgery ◽  
Breast Cancer Surgery
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