The use of a single local analgesics infusion in operation
cavity following mastectomy and its effect on postoperative
pain—a retrospective cohort study
Received: 27 August 2015 /Accepted: 19 April 2016 / Published online: 30 April 2016
Springer-Verlag Berlin Heidelberg 2016
Background Pain following mastectomy often require use of
opioids, drugs associated with a significant number of side
effects. This study investigated the effect of a single perioper-
ative infusion of bupivacaine in the mastectomy cavity on the
postoperative outcomes: use of opioids, pain score, and
Methods This retrospective cohort included 244 women un-
dergoing mastectomies at the Odense University Hospital,
Denmark. Thirty-five patients received bupivacaine in the
mastectomy cavity and were compared to 209 controls who
had no local analgesic.
Results A reduction in the postoperative use of 6.1 Boral mor-
phine equivalents^ (OMEQs) was observed in the infusion
group in the first 24 h after mastectomy compared to a control
group not receiving infusion. This corresponds to a reduction
of 6.1 mg of orally administered morphine, equivalent to a
52 % reduction. This was, however, not statistically signifi-
cant (p = 0.1208). No statistically significant differences be-
tween the two groups were found in visual analogue scale
(VAS) scores for pain and nausea or in the use of other
Conclusions A single perioperative infusion of bupivacaine
may have a morphine-sparing effect in the first 24 h after
mastectomy. Our results were however not statistically signif-
icant when tested on these low-pain surgical procedures.
Infusion of analgesics in surgical cavities is simple, fast, and
low cost. It might prevent the often seen vicious cycle of
nausea and impaired coping with postsurgical pain when pa-
tients are introduced to opioids.
Level of Evidence: Level III, therapeutic study.
Keywords Local analgesics
Oral morphine equivalents
Propensity score matching
Women undergoing breast surgery for breast cancer experi-
ence some degree of postoperative pain, often located to the
chest wall, breast, and scar . Pain after breast surgery is
generally mild to moderate and most prominent in the acute
phase . There is increasing evidence suggesting that acute
postoperative pain increases the risk of chronic pain. Chronic
postmastectomy or postlumpectomy pain syndrome is a well-
known complication with prevalence rates ranging from 20 to
68 % in people who have undergone breast surgery [1, 3–5].
Optimal postoperative care is therefore a keystone in reducing
the risk of chronic pain.
The current general postop regimen, supported by a review
in Acta Anaesthesiologica Scandinavica, consists of a combi-
nation of paracetamol and ibuprofen as first-line pain relief.
With the presence of pain requiring more analgesia, opioids is
regarded as the most effective . The use of opioids is how-
ever associated with side effects: sedation, dysphoria, nausea,
itching, and formications, all potentially causing a delay in
recovery . Use of baseline analgesics should therefore be
optimized in an attempt to reduce the use of opioids.
Administration of local analgesics (LA) during surgery
could be a useful addition to the current regimen of basic pain
* Martin Sollie
Department of Plastic Surgery, Odense University Hospital,
Sdr Boulevard 29, 5000 Odense C, Denmark
Eur J Plast Surg (2016) 39:273–278