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

Abstract

Andrea Saporito,1 José Aguirre,2 Alain Borgeat,2 Andreas Perren,3 Luciano Anselmi,1 Roberto Poggi,4 Bruno Minotti,5 Stefano Cafarotti,6 Davide La Regina,7 Samuele Ceruti81Service of Anesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland; 2Department of Anesthesiology, Balgrist University Hospital, Zürich, Switzerland; 3Department of Intensive Care, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland; 4Service of Anesthesiology, Ospedale Regionale di Lugano, Lugano, Switzerland; 5Department of Emergency Medicine, St Gallen General Hospital, St Gallen, Switzerland; 6Service of Thoracic Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland; 7Service of Visceral Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland; 8Department of Intensive Care, Geneva University Hospital (HUG), Geneva, SwitzerlandIntroduction: 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).Keywords: breast surgery, paravertebral block, regional anesthesia, postoperative pain

Keywords

• Breast surgery. Paravertebral block. Regional anesthesia. Post-operative pain.