Perioperative lidocaine infusion reduces the incidence of post-mastectomy chronic pain: a double-blind, placebo-controlled randomized trial

• Published in: Pain physician 2015-03, Vol.18 (2), p.E139-E146
• Main Authors: Terkawi, Abdullah S, Sharma, Sonal, Durieux, Marcel E, Thammishetti, Swapna, Brenin, David, Tiouririne, Mohamed
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthetics, Local - administration & dosage; Breast cancer; Breast implants; Breast Neoplasms - epidemiology; Breast Neoplasms - surgery; Chronic pain; Chronic Pain - diagnosis; Chronic Pain - drug therapy; Chronic Pain - epidemiology; Double-Blind Method; Double-blind studies; Female; Humans; Incidence; Infusions, Intravenous; Lidocaine - administration & dosage; Mastectomy; Mastectomy - adverse effects; Mastectomy - trends; Middle Aged; Pain, Postoperative - diagnosis; Pain, Postoperative - drug therapy; Pain, Postoperative - epidemiology; Perioperative Care - methods; Prospective Studies; Radiation therapy
• ISSN: 1533-3159; 2150-1149
• DOI: 10.36076/ppj/2015.18.E139

Chronic post-surgical pain (CPSP) is a not uncommon complication after mastectomy, with a reported incidence between 20% and 68%. Careful dissection, the use of minimally invasive surgical techniques, and attempts to reduce the associated inflammatory and hyperalgesic responses are suggested methods to prevent CPSP. To determine if the use of perioperative lidocaine infusion is associated with decreased incidence of CPSP after mastectomy. Double-blind, placebo-controlled randomized trial. This is a secondary analysis of data from 61 out of 71 patients who underwent mastectomy for breast cancer. Patients were randomized to either placebo (Group P; n = 27) or intravenous lidocaine (Group L; n = 34, bolus 1.5 mg/kg at induction, then infusion at 2 mg/kg/hr, up to 2 hours after the end of surgery) in a prospective double-blind design. CPSP was assessed at 6 months after surgery. Stepwise logistic regression analysis was performed to assess the efficacy of lidocaine. Overall 12 (20%) patients developed CPSP, 8 (30%) in the placebo group and 4 (12%) in the lidocaine group. Predictive factors for CPSP that remained significant after multivariate analysis included lidocaine (associated with a 20-fold decrease in CPSP, P = 0.013), breast implant placement (associated with a 16-fold increase in CPSP, P = 0.034), and radiotherapy (associated with a 29-fold increase in CPSP, P = 0.008). Small sample size. Perioperative lidocaine administration was associated with a decreased incidence of CPSP, while breast implant placement and radiotherapy were associated with an increased incidence. These findings suggest a protective effect of lidocaine on CPSP development in mastectomy patients.