Treatment of Post-Breast Surgery Pain Syndrome with Botulinum Toxin: Analysis of The Response to the Addition of Levobupivacaine and to the Type of Surgery

Background: The spasm and/or contracture of the pectoralis major contribute tothe post-breast surgery pain. The purpose of our study was to evaluate changes in thepost-breast surgical pain syndrome after the infiltration of botulinum-toxin type-A(BTX-A), according to the type of surgery and the reconstitution of the botulinumtoxin.Methods: This retrospective study was conducted at the RehabilitationDepartment with two cohorts: BTX-A reconstituted with saline solution (SS group)or with levobupivacaine (LV group). Data about pectoralis major contracture andpain (global, at night, at rest and during activity) before the infiltration and six weeksafter that were collected from the medical records and compared between SS and LVgroups, and between conservative breast surgery and mastectomy cases.Results: in the study, ۴۸ women aged ۵۳.۳ (±۱۱.۱۰) years were included, with ۲۶(۵۴.۲%) in SS group and ۲۲ (۴۵.۸%) in LV group. There were no differencesbetween both groups except transitory paresis (۳.۸% vs ۲۲.۷%; P=۰.۰۲۲). In allpatients, baseline circumstances vs after ۶ weeks were compared, and we foundsignificant differences in contracture (۱,۷۷ (±۰.۵۷) vs ۰.۹۷ (±۰.۷۹)), VAS global(۵.۴۵ (±۱.۹۲) vs ۳.۴۶ (±۲.۴۸)), VAS night (۳.۱۷ (±۳.۱۳) vs ۱.۶۱ (±۲.۲۹)), VAS rest(۲.۱۴ (±۲.۵۶) vs ۱.۲۱ (±۱.۹۸)) and VAS activity (۴.۳۱ (±۲.۵۵) vs ۲.۷۸ (±۲.۵۸)). Wefound higher improvements in the breast conservative surgery.Conclusion: A significant lower pain and contracture after BTX-A injection inthe pectoralis major was observed, but its reconstitution in levobupivacaine may notbe an effective method to increase the analgesic effect. There were higherimprovements in the breast conservative surgery than in the mastectomy.

کلیدواژه ها:

Post-mastectomy pain syndrome ، post-breast-surgery pain syndrome ، breast cancer ، botulinum toxin