ABSTRACT

Background: Post-operative pain is one of the many distressing outcomes of breast surgery. It has been described that more than 50 % of the patients experience severe acute postoperative pain and about 8% of those suffer from chronic persistent pain. According to multiple studies, pain after modified radical mastectomy (MRM) is 23% to 40%. Pain causes significant emotional and physical discomfort, endocrine dysfunction, impairs wound healing, causes cardiopulmonary and thromboembolic complications.

Methods: This randomized control trial was conducted at the department of general surgery, Dow University Hospital Karachi. All females, ages ranged between 20 to 80 years and diagnosed with breast carcinoma stage II based on triple assessment were recruited in the study. Patients underwent modified radical mastectomy and assessed at 12 and 24 hours postoperatively, for pain scores at rest and arm mobilization using VAS pain score, a number of times rescue analgesia when VAS-score >3 by residents of surgery blinded to the study. Those patients, who experience pain (pain score >3) in spite of routine analgesics received injection ketorolac 30mg once, pain score between 3 to 6 received injection Kinz, pain score > 7 were given both analgesics single times, pain score > 8 will receive intravenous maximum thrice in 24 hours. Patients with pain scores 0-2 were not given any additional analgesics. The outcome variables of the study were age, pain score (VAS), and analgesic requirement.

Result: A total of 102 patients were recruited, 51 in each group. In our study, no group was found immune to pain. At initial 12 hours post operatively, in control group mean pain was 3.37±0.56, and pain was 3.02±0.14 in case group when arm was at rest. Increase in pain was observed in arm mobilization. Control and case group mean pain on ipsilateral arm mobilization was 3.72±0.49 versus 3.12±0.33 respectively. Additional analgesic requirement was also decreased from 93.8% in control group to 58.3 % in study group (p <0.001).

Conclusions: Gabapentin has shown to be effective in significant pain reduction.

Keywords: Carcinoma breast, Modified radical mastectomy, pain score, post-operative pain