Systemic Lidocaine May Be Effective for Postmastectomy Pain

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Currently, there is no established prophylactic treatment for mastectomy-related pain.
Currently, there is no established prophylactic treatment for mastectomy-related pain.

Intraoperative systemic lidocaine may reduce chronic persistent postmastectomy pain at 6 months after surgery, according to results from a randomized, double-blind, placebo-controlled trial published in Pain Practice.1

Investigators randomly assigned patients to receive 1.5 mg/kg bolus of intravenous lidocaine with a 2 mg/kg/hour infusion (n=75), or 1.5 mg/kg bolus of normal saline with 2 mg/kg/hour infusion (n=75).

The presence of chronic persistent postsurgical pain was evaluated using a binary yes/no pain assessment and the IMMPACT (Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials) recommendations.2

No significant difference in pain burden, recovery quality, or opioid consumption at 24 hours was found between patients receiving intravenous lidocaine or saline. Surgery-related pain at 6 months was reported by 13% vs 29% of study participants in groups 1 and 2, respectively (P =.04). Three patients in group 1 (5%) and 2 patients in group 2 (3%) met criteria for persistent postoperative pain; however, this finding was not considered statistically significant (P =.99).

The investigators believe the findings of this trial hold clinical relevance “because the prevalence of chronic postsurgical pain has been considered to occur in up to 60% of women undergoing breast surgery, with no established methods of prevention currently established.”

Study Limitations

  • Pain was assessed with subjective tests
  • The sample size was limited
  • Only IMMPACT was used to assess pain

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References

  1. Kendall MC, McCarthy RJ, Panaro S, et al. The effect of intraoperative systemic lidocaine on postoperative persistent pain using initiative on methods, measurement, and pain assessment in clinical trials criteria assessment following breast cancer surgery: a randomized, double-blind, placebo-controlled trial [published online July 10, 2017]. Pain Pract. doi: 10.1111/papr.12611
  2. Dworkin RH, Turk DC, Farrar JT, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113:9-19.
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