To infiltrate or not? Acute effects of local anaesthetic in breast surgery

There is limited evidence to support use of local anaesthetic (LA) wound infiltration in breast surgery. This study seeks to examine whether wound infiltration of bupivacaine (0.25%) decreases post-operative pain and analgesic use, without increasing post-operative complications.

A prospective single-blind study was undertaken of 90 patients undergoing breast lump excision, wide local excision and mastectomy with or without axillary surgery. Patients were randomized to receive infiltration with bupivacaine (0.25%) into the surgical wound (Group LA) or no infiltration (Group No LA). Data on post-operative analgesia use was collected. Pain scores were assessed at 1, 24, 48 h and 1 week with a visual analogue scale. Complications associated with wound healing were documented at the first post-operative visit.

Forty-five patients received infiltration and 34 patients received none. There were no significant differences in baseline characteristics between patient groups or surgical details. Analysis revealed Group LA used significantly less opioids than Group No LA during the first 48 h post-op (3.42 mg versus 7.33 mg; P = 0.02). Overall, Group LA used half the total average opioid equivalent amount (5.04 mg versus 10.08 mg; P = 0.069). There were no significant differences in post-operative pain scores or complications. Overall pain scores were low, suggesting effective analgesic use by nursing staff.

LA infiltration during breast surgery has a marked opioid sparing effect, which has significant patient benefits as well as reducing nursing workload and drug costs.