Long-Term Outcomes of Breast Cancer Patients Receiving Levobupivacaine Wound Infiltration or Diclofenac for Postoperative Pain Relief

Author:

Glavas Tahtler Josipa12,Djapic Dajana12,Neferanovic Marina2,Miletic Jelena2,Milosevic Marta2,Kralik Kristina2ORCID,Neskovic Nenad12ORCID,Tomas Ilijan23,Mesaric Dora23,Marjanovic Ksenija24,Rajc Jasmina24,Orkic Zelimir25,Cicvaric Ana12,Kvolik Slavica12ORCID

Affiliation:

1. Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia

2. Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia

3. Department of Oncology and Radiotherapy, Osijek University Hospital, 31000 Osijek, Croatia

4. Department of Pathology and Forensic Medicine, Osijek University Hospital, 31000 Osijek, Croatia

5. Department of Surgery, Osijek University Hospital, 31000 Osijek, Croatia

Abstract

Breast cancer is the most common malignant disease in women. Preclinical studies have confirmed that the local anesthetic levobupivacaine has a cytotoxic effect on breast cancer cells. We examined whether postoperative wound infiltration with levobupivacaine influences survival in 120 patients who were operated on for breast cancer and underwent quadrantectomy or mastectomy with axillary lymph node dissection. Groups with continuous levobupivacaine wound infiltration, bolus wound infiltration, and diclofenac analgesia were compared. Long-term outcomes examined were quality of life, shoulder disability, and hand grip strength (HGS) after one year and survival after 5 and 10 years. Groups that had infiltration analgesia had better shoulder function compared to diclofenac after one year. The levobupivacaine PCA group had the best-preserved HGS after 1 year (P = 0.022). The most significant predictor of the 5-year outcome was HGS (P = 0.03). Survival at 10 years was 85%, 92%, and 77% in the diclofenac, levobupivacaine bolus, and levobupivacaine PCA groups (ns. P = 0.36). The extent of the disease at the time of surgery is the most important predictor of long-term survival (P = 0.03). A larger prospective clinical study could better confirm the effect of levobupivacaine wound infiltration on outcomes after breast cancer surgery observed in this pilot study—trial number NCT05829707.

Funder

University J.J. Strossmayer in Osijek, Medical faculty, Osijek Croatia

Publisher

MDPI AG

Subject

Pharmaceutical Science

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