POST-OPERATIVE ANALGESIA FOLLOWING MODIFIED RADICAL MASTECTOMY: THE ROLE OF 0.25% BUPIVACAINE SURGICAL WOUND IRRIGATION

Abstract

Background: Traditional methods of analgesia in the postoperative setting often include systemic medications such as opioids and non-steroidal anti-inflammatory drugs (NSAIDs). While effective, these medications come with a range of side effects, including sedation, nausea, constipation, and the potential for dependency. One such method is the use of local anesthetics for surgical wound irrigation, particularly bupivacaine. Being a long-acting local anesthetic, has been shown to provide effective analgesia when administered via wound irrigation during surgical procedures.

Material & Methods: All patients received a standard anesthetic protocol. Fentanyl was administered at a rate of 0.5mcg/hour from the beginning of surgery until the wound closure. Patients were randomly assigned to one of two groups:-Control Group:

Received routine postoperative pain management and Study Group: Underwent an additional procedure prior to wound closure. A 20G scalp vein set was prepared for a continuous irrigation catheter using sterile techniques. Pain scores were recorded using a Visual Analogue Scale (VAS) every six hours for 24 hours postoperatively.

Results: Overall, the data suggests that the Study Group experienced significantly less pain and required fewer doses of rescue analgesia in the first 24 hours post-surgery compared to the Control Group. However, other parameters such as age, weight, surgery duration, and fentanyl dosage did not show significant differences between the groups. Overall, the data suggests that there are no significant differences in ASA classification or Mallampatti scores between the Study and Control Groups. However, there is a statistically significant reduction in the occurrence of post-operative nausea and vomiting in the Study Group,

Conclusion: The study highlights its efficacy in reducing pain scores and minimizing opioid consumption, thereby enhancing patient comfort and satisfaction during recovery.

This technique offers a targeted analgesic approach that can potentially improve clinical outcomes and align with multimodal pain management strategies.