Levobupivacaine Prolonged Wound Infusion for Postoperative Pain Relief After Breast Surgery
Levobupivacaine Prolonged Wound Infusion for Postoperative Pain Relief After Breast Surgery
The aim of the study is to evaluate efficacy and safety of long term (14 days) wound infusion
 with levobupivacaine in patients with breast cancer undergoing mastectomy with immediate
 breast reconstruction: this is a double blind, randomized, parallel group study. The study
 moves from the concept that nociceptive stimulus last further than 48 hours after surgical
 intervention: long term analgesia is necessary to provide a real benefit to the patient and
 provide central sensitization. Intralesional catheter is placed at the end of surgery. In the
 first 24 postoperative hours we provide continuous wound infusion with levobupivacaine 0,25%
 5ml/h with morphine Patient Controlled Analgesia (PCA) when NRS >4. From the second
 postoperative day morphine PCA is removed and patients are randomized to receive
 levobupivacaine 0,25% or saline, released with 5 ml boluses and lock-out of 2 hours, with
 rescue analgesia with tramadol 37,5 mg + acetaminophen 325 mg oral fix combination (Patrol).
 Intralesional catheter is taken off 14 days after surgical intervention or after 36 hours of
 non-use.

 Pain evaluation (NRS at rest and movement) and oral rescue doses consumption are performed;
 pain physicians also care about any catheter-related or drug-related side effect, registering
 number of total boluses. Patients are provided with a home diary for pain scores to be filled
 and brought back when surgical visit is performed. A phone interview at 1 and 3 month is
 performed to investigate pain chronicization.

 Surgical evaluation is provided, also to establish any catheter-related infective or healing
 complication.

 Physiatric evaluation before the intervention and 1 and 3 months is provided to ensure
 rehabilitation process.

 A validated questionnaire (short form 36/ SF-36) must be filled by all patients, to
 understand differences in return to a normal quality of life and to social activities between
 the two groups.
Inclusion Criteria:

 -  F; age 18 to 70

 -  American Society of Anesthesiologists (ASA) I e II;

 -  breast cancer ( DIN 2 e 3, o LIN 2 e 3 sec. Tavassoli) scheduled for nipple-sparing
 mastectomy, simple mastectomy, skin-sparing mastectomy, skin-reducing mastectomy c,
 lymphnode biopsy and axillary dissection;

 -  immediate sub-pectoral prosthetic reconstruction;

 -  signed informed consent.

 Exclusion Criteria:

 -  preexisting pectoral, axillar, thoracic homolateral pain

 -  habitual opioid consumption;

 -  drug-alcoholics addiction ;

 -  ICU postoperative recovery;

 -  kidney failure (creatinin > 2 g/dl, creatinin <clearance 30 ml/h) and/or hepatic
 failure (cholinesterase < 2000 UI);

 -  cardiac arrhythmias o;

 -  Epilepsy;

 -  Psychiatric, cognitive disorders, mental retardation;

 -  Coagulopathies (INR > 2, activated partial thromboplastin time - aPTT>44 sec);

 -  platelet count less than 100.000/mm3;

 -  BMI > 30;

 -  Allergies to study drugs.