Does the perioperative analgesic/anesthetic regimen influence the prevalence of long-term chronic pain after mastectomy?

Arnaud Steyaert (Corresponding Author), Patrice Forget, Virginie Dubois, Patricia Lavand'homme, Marc De Kock

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Study Objective
To investigate if the anesthetic/analgesic regimen is associated with the risk of reporting long-term chronic postmastectomy pain (CPMP).

Cross-sectional survey

Academic hospital

A total of 267 women having undergone mastectomy with axillary lymph node dissection between 2003 and 2008

All patients were contacted between October and December 2012, with a questionnaire asking for persistent pain after surgery and its characteristics.

Besides demographical data, tumor characteristics, and adjuvant treatment, we recorded type and doses of intraoperative anesthetics/analgesics (sufentanil, ketamine, clonidine, nonsteroidal anti-inflammatory drugs, MgSO4, propofol, or halogenated agents).

Of the 128 patients returning analyzable questionnaires, 43.8% reported chronic pain (48.2% with neuropathic characteristics). Multivariate logistic/linear regression model showed 4 factors independently associated with persistent pain: recall of preoperative pain (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.09-1.48), chemotherapy (OR, 1.32; 95% CI, 1.13-1.55), need for strong opioids in postanesthesia care unit (OR, 1.30; 95% CI, 1.11-1.53), and halogenated agent anesthesia (OR, 0.81; 95% CI, 0.70-0.95).

In conclusion, our study confirms the high prevalence of CPMP, 4 to 9 years after surgery. Recall of preoperative pain, chemotherapy, and need for strong opioids in the postanesthesia care unit were all associated with the presence of chronic pain. Of the intraoperative analgesics/anesthetics studied, only use of halogenated agents was associated with a lower prevalence of CPMP.
Original languageEnglish
Pages (from-to)20-25
Number of pages6
JournalJournal of Clinical Anesthesia
Early online date6 Apr 2016
Publication statusPublished - Sept 2016

Bibliographical note

The authors would like to thank Pr. Martine Berlière (surgeon, department of Gynecology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain) for her support during this study.


  • chronic postsurgical pain
  • Chronic postmastectomy pain
  • postoperative pain
  • breast cancer


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