Chronic Pain Clinical Trial
Official title:
Effect of Locally Administered Morphine and Bupivicaine on Acute and Chronic Postmastectomy Pain
This study investigate the effect of addition morphine to locally instillation bupivacaine on developing chronic neuropathic pain acute postoperative pain after breast cancer surgery and on the probability of developing chronic neuropathic pain.
Breast cancer is one of the most common cancer diagnoses in women and a significant cause of
mortality and morbidity worldwide.Surgical treatment indicated in most patients. Persistent
pain and sensory disturbances following surgery is a significant clinical problem with an
average prevalence of 20-23.9%. Post-mastectomy chronic pain syndrome (PMPS) is defined as
pain of neuropathic character located in the area of surgery and/or the ipsilateral arm,
present at least 4 days per week, and with an average intensity of at least 3 on a numeric
rating scale from 0 to 10. The pathological mechanisms may be related to patient
characteristics, surgical technique and adjuvant therapy. Although the genesis of pain is
multi-factorial, sectioning of the intercostobrachial nerve (a cutaneous branch of T1-2) is
the nerve lesion diagnosed most often.
Uncontrolled acute postoperative pain is defined as an important risk factor for the
development of chronic pain. Local anesthetics have been investigated in cancer breast
patients through many routes; paravertebral blocks, thoracic epidurals, wound infiltration,
topical lidocaine patch, and the topical application of EMLA( Eutectic Mixture of Local
Anesthetics) cream on operation site. Most of above studies suggested a better outcome in
terms of reduced postoperative pain and improved patient satisfaction.
Opioids exert a local analgesic effect is based on several observations: • Nociceptive
afferent nerve fibers contain peripheral opioid receptors which are silent except in the
presence of local inflammation. • Morphine and its metabolites are largely undetectable
systemically when applied topically to skin ulcers, suggesting the analgesic effect is local
• Peripheral opioid injections for local analgesia, such as intra-articular morphine after
knee surgery, have been found to be effective in several trials. An effective topical opioid
analgesic that could be applied to inflamed or open skin lesions would be a useful option
for some patients where other options for pain relief have been exhausted.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Crossover Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment
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