Chronic Pain and Minor Breast Cancer Surgery
Chronic Pain and Minor Breast Cancer Surgery
Breast cancer is the most frequent in women. Early diagnosis and recent treatments have
 improved overall mortality. However, chronic pain (pain lasting more than 3 months after
 surgery) remains a public health problem with impact on quality of life for these patients.
 The incidence of pain has been reported up to 25 to 60% of patients in the literature, even
 many years after a radical mastectomy. The neuropathic component of the pain is usually
 underestimated. In a prospective cohort study we have demonstrated that 43% of patient needed
 on average 5mg of morphine intravenously in the recovery room after a conservative breast
 cancer surgery, despite a multimodal regimen of analgesic drugs. In the same study, 40% of
 patients reported persistent pain 3 months after the surgery. To improve the analgesia in
 such a population, we decided to introduce regional analgesia technique (serratus block)
 systematically. This became our gold standard in our daily practice. We would like to assess
 the efficacy of such regional analgesia techniques on opioids consumption in the recovery
 room and the incidence of pain 3 months after conservative breast cancer surgery.
This is a prospective observational study assessing the interest of preoperative thoracic
 block (injection of local anesthetic around the serratus muscle under ultrasound guidance) in
 the prevalence of chronic pain 3 months after a conservative breast cancer surgery.

 Information on the present survey was given during pre-operative consultation and signed
 informed consent was obtained to enter the study.

 The management of patients undergoing minor surgery for breast cancer is standardized within
 our department and reported in our previous study. After starting the induction of anesthesia
 and insertion of a laryngeal mask, a regional analgesia technique was performed under
 ultrasonography. Twenty ml of ropivacaine 3.75mg/ml were injected under the serratus muscle,
 at the lateral edge of the minor pectoralis muscle. In the absence of contraindications,
 multimodal analgesia consisted of paracetamol, non-steroidal anti-inflammatory drugs and
 nefopam. Postoperative intravenous morphine titration was possible in patients presenting a
 pain score >3/10 (numeric pain intensity scale from 0 = no pain to 10 = maximum imaginable
 pain) in the recovery room. If 0.1mg/kg of morphine did not permit to alleviate pain,
 ketamine titration was initiated by the anesthesiologist.

 The incidence of patients that required opioids titration in the recovery room (and the dose
 injected) was recorded.

 The questionnaire sent to the patients 3 months after their surgery was mainly composed of
 closed questions. This questionnaire included pain score, location of pain, analgesic drugs
 consumption, neuropathic component (self-administered questionnaire derived from the
 Neuropathic Pain 4 Questions - DN4 questionnaire), impact of quality of life using the Brief
 Pain Inventory.
Inclusion Criteria:

 -  women

 -  > 18 years old

 -  with "American Society of Anesthesiologists-ASA" physical status 1 to 3

 -  with unilateral breast cancer adenocarcinoma treated surgically by conservative
 tumorectomy associated or not to sentinel lymph node dissection on an ambulatory basis

 Exclusion Criteria:

 -  None