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Intravenous lidocaine may ease neuropathic pain after breast cancer surgery

16 Aug 2019
Mastectomy requires the removal of both breasts even when tumour is only present in one side

Intravenous lidocaine may offer significant neuropathic pain relief after breast cancer surgery, a new study has shown.

Researchers conducted a multicentre, two-by-two factorial randomized placebo-controlled trial including 100 female patients (mean age, 54.3±11.1 years) receiving breast cancer surgery. Participants were randomly assigned to receive intraoperative lidocaine or placebo and perioperative pregabalin or placebo.

After 3 months of follow-up, more than half (53 percent) of the patients reported experiencing persistent neuropathic pain. A large majority (77.4 percent) suffered from mild pain while at rest, while 15.1 percent and 7.5 percent reported moderate and severe pain, respectively. Upon movement, the prevalence of moderate and severe pain grew to 17.0 percent and 13.2 percent, respectively.

Lidocaine significantly suppressed the development of persistent neuropathic pain relative to placebo (43.1 percent vs 63.3 percent; relative risk [RR], 0.68, 95 percent CI, 0.47–1.0; p=0.049), though no such effect was reported for moderate-to-severe persistent neuropathic pain (7.8 percent vs 16.3 percent; RR, 0.48, 0.16–1.49; p=0.205).

Pregabalin, on the other hand, did not result in significant improvements in persistent neuropathic pain (60 percent vs 46 percent; RR, 1.3, 0.90–1.90; p=0.166) or that of moderate-to-severe intensity (12 percent vs 12 percent; RR, 1.00, 0.35–2.89; p=1.00).

Notably, there was also no significant interaction between lidocaine and pregabalin (52 percent vs 58.3 percent; RR, 0.89, 0.54–1.48; p=0.656).

“Persistent pain after breast cancer surgery is a common problem, and there are no established interventions known to reduce its development. Results of this pilot trial are encouraging and provide insights into developing a larger definitive trial,” said researchers.

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Natalia Reoutova, 07 Jan 2020

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