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Chronic Postsurgical Pain Outcomes in Breast Reconstruction Patients Receiving Perioperative Transversus Abdominis Plane Catheters at the Donor Site: A Prospective Cohort Follow-Up Study

Authors

  • Justin Oh,

    1. Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
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  • Gabrielle M. Pagé,

    1. Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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  • Toni Zhong,

    1. Division of Plastic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Canada
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  • Stuart McCluskey,

    1. Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
    2. Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada
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  • Coimbatore Srinivas,

    1. Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
    2. Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada
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  • Anne C. O'Neill,

    1. Division of Plastic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Canada
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  • James Kahn,

    1. Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
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  • Joel Katz,

    1. Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
    2. Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada
    3. Department of Psychology, York University, Toronto, Ontario, Canada
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  • Stefan O P Hofer,

    1. Division of Plastic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Canada
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  • Hance Clarke

    Corresponding author
    1. Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
    2. Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada
    • Address correspondence and reprint requests to Hance Clarke, MD, PhD, FRCPC, Pain Research Unit 3EB-317, Department of Anaesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M4Y 1H1, Canada. E-mail: hance.clarke@utoronto.ca

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  • This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/phar.12550

Abstract

Background

Chronic postsurgical pain (CPSP) is a debilitating and costly condition. Risk factors for CPSP after autologous breast reconstruction have not been clearly established. Previously, we demonstrated that transversus abdominis plane (TAP) catheters delivering intermittent local anesthetic reduced postoperative morphine consumption. This prospective follow-up study aims to (1) compare the incidence of CPSP after autologous breast reconstruction between patients who received postoperative intermittent TAP catheters with bupivacaine or saline boluses and (2) assess the factors that contribute to the development and maintenance of CPSP in this study cohort.

Methods

Ninety-three patients who underwent deep inferior epigastric artery perforator or muscle-sparing transverse rectus abdominis breast reconstruction were randomized to receive TAP catheters with bupivacaine or saline postoperatively. Subsequently, patients were followed for a year to assess persistent pain, pain severity, quality of life scores, and functional disability at 6 and 12 months after surgery.

Results

Twenty-four percent and 23% of patients reported CPSP at 6 and 12 months, respectively. There were no significant differences between groups (bupivacaine vs. placebo) on pain-related variables, including incidence of CPSP. Patients who reported greater variability in pain scores at rest over the first 48 hours postoperatively were more likely to have CPSP 6 months, but not 12 months, later.

Conclusions

Acute postoperative pain variability may contribute to the development of CPSP up to 6 months after autologous breast reconstruction surgery. Neither postoperative use of bupivacaine vs. saline in the TAP catheters nor acute pain severity influenced the 6- or 12-month incidence of CPSP.

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