Syed Mansoor Yousuf, Irfan Sohail, Rabia Arshad, Julie Cox, Amir Bhatti.
Improving post-operative analgesia in mastectomy patients by instillation of local anaesthetic into the surgical drain.
Pak J Surg Jan ;35(2):84-8.

Objective: Mastectomy is a surgical procedure which compounds psychological suffering with post-operative pain. Local anaesthetic instillation through a surgical drain is a widely utilised intervention which may improve post-operative analgesia Material and Methods: Retrospective service evaluation involving a cohort of patients over a four-year time frame comparing two sub-cohorts, one in which the surgeon had adopted the service improvement and with one surgeon who had not. Anaesthesia was standard with intravenous induction with alfentanil, propofol, laryngeal mask insertion followed by maintenance with sevoflurane. In the sub-cohort of patients in which local anaesthetic (40 ml of 2.5 mg/ml levobupivacaine) was instilled into mastectomy wound drain post-procedure, the drain clamp was released aft er 30 minutes. Comparison was made with the sub-cohort who did not have instillation of local anaesthetic. Results: A total of 89 women, were evaluated in 2 groups, group-A (62) treated with infiltration of bupivacaine through surgical drains, and group-B (27) had local infiltration of bupivacaine along the surgical incision. Post-operative morphine consumption was 15%(9) less in group-A then in local infiltration group-B that was 67%(18) which was statistically significant. Also in the group-A. Th e median post-operative pain scores at rest as well as on movement were higher in local infiltration group than in group-B. Oral paracetamol as first analgesia was 85%(53) before discharge from hospital in group-A compared with group-B 33%(9) which was statistically significant Conclusions:Local anaesthetic instillation through a surgical drain aft er mastectomy is an established low risk intervention which may provide improved post-operative analgesia and decrease the oral analgesic requirements. We believe this technique has considerable promise and requires rigorous evaluation incorporating careful matching of patient groups to avoid selection bias and standardisation of instillation technique as well as assessment of agreed endpoints and complications.

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