Subramaniam Anand
Background: The role axillary lymph node dissection (ALND) in staging, prognostic assessment and local control in patients of breast cancer with clinically evident disease in the axilla is well established. ALND has its share of morbidity in the form of restriction of range of motion of arm, pain, paraesthesia and lymphedema influencing quality of life. This prospective study evaluates the effect of infiltrative anaesthesia injected along the nerve bundles exposed during ALND in reducing the restriction of range of motion of arm and pain scores following ALND.
Methods: A total of 60 ALND in patients of operable invasive breast cancer were randomized in to two groups:- Group 1: The control group where patients of ALND were managed in the postoperative period with standard analgesia of injection acetaminophen 1 gm 8 hourly and early arm and shoulder movements from the evening of the procedure. Group 2: The test group had 5 ml of 0.125% Bupivaccaine injected each around the three nerve bundles exposed during ALND along with early arm and shoulder exercises and standard analgesia similar to the control group. Medical records of patients were analysed for age, laterality, clinical staging, histopathological parameters and surgical complications. Range of motion of ipsilateral at the shoulder and pain scores as recorded by visual analog scale (VAS) were objectively noted on day 0 to day 28 postoperatively at various intervals.
Results: The range of motion at ipsilateral shoulder was measured by flexion, abduction and extension. The degrees of flexion and abduction were found to have statistically significant difference on Days 0, 3 and 7 in the test group in comparison to control group (p=0.001 for flexion on all Day 0,3 and 7 and p=0.009 for Day 0, p=0.001 for Day 3 and p<0.001 for Day 7 for abduction). Extension was better in the test group on Days 0 and 3 (p<0.001 and p=0.005 respectively). Pain scores assessed by VAS were significantly lower in test group when compared to control group on Days 0,1, 3 and 7 (p ≤ 0.01). There was no statistically significant difference in the restriction of flexion, extension and abduction and pain scores on Day 28 between the groups. Analgesia requirement was significantly reduced in the test group on days 0 and 1 (p ≤ 0.05).
Conclusion: Infiltrative anaesthesia with 0.125% bupivaccaine along the nerve bundles exposed during ALND improves range of motion at shoulder and pain scores in the immediate postoperative period in patients of breast cancer.
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