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PAIN MEDICINE

Multimodal Analgesia with Gabapentin and Local Anesthetics Prevents Acute and Chronic Pain After Breast Surgery for Cancer

Argyro Fassoulaki, MD, PhD, DEAA^*, Argyro Triga, MD, Aikaterini Melemeni, MD^*, and Constantine Sarantopoulos, MD, PhD, DEAA

*Department of Anesthesiology, Aretaieion Hospital, Medical School, University of Athens; Department of Anesthesiology, St. Savas Hospital, Athens, Greece; and Department of Anesthesiology, Medical College of Wisconsin, Milwaukee

Address correspondence and reprint requests to A. Fassoulaki, MD, PhD, DEAA, 57-59 Raftopoulou St., 11744 Athens, Greece. Address e-mail to afassou1{at}otenet.gr or fassoula{at}aretaieio.uoa.gr.

We evaluated the effect of multimodal analgesia on acute and chronic pain after breast surgery for cancer. Fifty patients scheduled for breast cancer surgery were blindly randomized to receive gabapentin, eutectic mixture of local anesthetics cream, and ropivacaine in the wound or three placebos. Pain (visual analog scale) and analgesics were recorded in the postanesthesia care unit (PACU) 3, 6, and 9 h and 8 days after surgery. Three and 6 mo later, patients were assessed for chronic pain. The treatment group consumed less paracetamol in the PACU (469 versus 991 mg; P < 0.002) and less Lonalgal® (1.0 versus 4.4 tablets; P = 0.003) than the controls, exhibited lower visual analog scale scores at rest in the PACU (P = 0.001) and on postoperative Days 1, 3, and 5 (P = 0.040, P = 0.015, and P = 0.045, respectively), and after movement in the PACU (P = 0.001) and on postoperative Days 2, 4, and 8 (P = 0.028, P = 0.007, and P = 0.032, respectively). Three and 6 mo after surgery, 18 of 22 (82%) and 12 of 21 (57%) of the controls reported chronic pain versus 10 of 22 (45%) and 6 of 20 (30%) in the treatment group (P = 0.028 and P = 0.424, respectively); 5 of 22 and 4 of 21 of the controls required analgesics versus 0 of 22 and 0 of 20 of those treated (P = 0.048 and P = 0.107, respectively). Multimodal analgesia reduced acute and chronic pain after breast surgery for cancer.

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