ABSTRACT

Inappropriate acute postoperative pain management after breast cancer surgery has been associated with the development of chronic postmastectomy pain syndrome 'PMPS'. The aim of this study was to investigate the analgesic effect of tramadol versus tramadol and bupivacaine locally administered postoperatively before skin closure in patients undergoing surgery for cancer breast.

Ninety female patients randomly assigned into three groups (30 patients each); group Control received 20 ml 0.9% saline, group Tramadol received 100 mg tramadol in 20 ml 0.9% saline and group Tramadol+ received 100 mg tramadol in 20 ml plain bupivacaine 0.25%.The study drugs were irrigated by a 20-ml syringe locally postoperatively before skin closure. Pain severity, time to first request of rescue analgesic, analgesic consumption and incidence of side effects were recorded in the 1st 48 hours postoperative. The incidence of neuropathic pain was assessed using DN4 Questionnaire scores in the 1st,2nd,and 3rd months postoperative.

Pain score in Tramadol and Tramadol+ group was reduced at 4,6,12,24,36,and 48 hours postoperative compared to the Control group (p<0.001). The time to 1st request of rescue analgesia was prolonged in Tramadol and Tramadol+ groups compared to Control group (p<0.001). The total consumption of rescue analgesia was reduced in Tramadol and Tramadol+ groups compared to Control group (p<0.01).There was no difference in the incidence of side effects in the three groups .The incidence of neuropathic pain (NP) was significantly reduced in Tramadol and Tramadol+ groups compared to Control group. Study parameters showed no difference between Tramadol and Tramadol+ groups.

Postoperative local administration of tramadol significantly reduces early acute postoperative pain and the incidence of development of chronic neuropathic pain after cancer breast surgery, to a level comparable to the combined use of tramadol and bupivacaine