Treatment of Post-Breast Surgery Pain Syndrome with Botulinum Toxin: Analysis of The Response to the Addition of Levobupivacaine and to the Type of Surgery

Abstract

Background: The spasm and/or contracture of the pectoralis major contribute to the post-breast surgery pain. The purpose of our study was to evaluate changes in the post-breast surgical pain syndrome after the infiltration of botulinum-toxin type-A (BTX-A), according to the type of surgery and the reconstitution of the botulinum-toxin. Methods: This retrospective study was conducted at the Rehabilitation Department with two cohorts: BTX-A reconstituted with saline solution (SS group) or with levobupivacaine (LV group). Data about pectoralis major contracture and pain (global, at night, at rest and during activity) before the infiltration and six weeks after that were collected from the medical records and compared between SS and LV groups, and between conservative breast surgery and mastectomy cases. Results: in the study, 48 women aged 53.3 (±11.10) years were included, with 26 (54.2%) in SS group and 22 (45.8%) in LV group. There were no differences between both groups except transitory paresis (3.8% vs 22.7%; P=0.022). In all patients, baseline circumstances vs after 6 weeks were compared, and we found significant differences in contracture (1,77 (±0.57) vs 0.97 (±0.79)), VAS global (5.45 (±1.92) vs 3.46 (±2.48)), VAS night (3.17 (±3.13) vs 1.61 (±2.29)), VAS rest (2.14 (±2.56) vs 1.21 (±1.98)) and VAS activity (4.31 (±2.55) vs 2.78 (±2.58)). We found higher improvements in the breast conservative surgery. Conclusion: A significant lower pain and contracture after BTX-A injection in the pectoralis major was observed, but its reconstitution in levobupivacaine may not be an effective method to increase the analgesic effect. There were higher improvements in the breast conservative surgery than in the mastectomy.

Keywords

• Post-mastectomy pain syndrome
• Post-breast-surgery pain syndrome
• Breast cancer
• Botulinum toxin