Albi-Feldzer, A., Mouret-Fourme, E.E., Hamouda, S., Motamed, C., Dubois, P.Y., Jouanneau, L., & Jayr, C. (2013). A double-blind randomized trial of wound and intercostal space infiltration with ropivacaine during breast cancer surgery: Effects on chronic postoperative pain. Anesthesiology, 118, 318–326.

To evaluate the short- and long-term effects of ropivacaine wound infiltration on pain after breast cancer surgery

Patients were randomized to receive, prior to surgery, either ropivacaine or normal saline placebo wound infusion. All patients received the same general anesthesia regimen of propofol and sufentanil. At the end of surgery, before skin suturing, the wound was completely infiltrated along the subcutanous and deep layers of the breast and axilla surgical incisions. Infiltration was also done in the second and third intercostal spaces. The ropivacaine group received 3 mg/kg of 0.375% ropivacaine. Pain was assessed every 30 minutes for two hours in the postanesthesia care unit and every six hours for the next 48 hours. Patients completed study questionnaires at baseline and at 3, 6, and 12 months after surgery.

• The sample was composed of 236 patients.
• Mean patient age was 56.5 years.
• All patients were female.
• All patients were undergoing surgery for breast cancer; 45%–52% had breast-conserving surgery with axillary node dissection, and 40%–45% had mastectomy with either axillary or sentinel lymph node dissection.

• Single site
• Multiple settings
• France

Mutliple phases of care

Randomized double-blind placebo-controlled trial

• Visual analog scale (VAS) to assess pain
• Brief Pain Inventory
• Hospital Anxiety and Depression Scale

• During the first 90 minutes, with patients at rest and with movement, VAS pain scores were lower in the group that received ropivacaine (p < 0.001) than in the control group.
• Over the first 48 hours in the ropivacaine group, 73% reported no pain at rest and 53% reported no pain during movement. Over the first 48 hours in the control group, 53% reported no pain at rest and 48% reported no pain during movement (p < 0.001).
• In the first 48 postoperative hours, authors noted no differences between groups in regard to morphine consumption.
• At 3, 6, and 12 postoperative months, authors noted no differences between groups in regard to pain scores.

Surgical wound infusion with ropivacaine resulted in significantly lower acute postoperative pain as measured up to 48 hours after breast cancer surgery. Wound infusion had no effect on longer-term postoperative pain.

Authors did not describe chronic levels of pain at follow-up time points.

Local wound infusion resulted in significantly lower acute postoperative pain after breast cancer surgery. This study adds to the body of evidence that demonstrates the effectiveness of this approach. Nurses can advocate for this approach to help ensure that surgical patients receive effective acute pain management.