1. 2015;18;E139-E146Perioperative Lidocaine Infusion Reduces the Incidence of Post-Mastectomy Chronic Pain: A Double-Blind, Placebo-Controlled Randomized Trial
   Randomized Trial
   Mohamed Tiouririne, MD, David Brenin, MD, Abdullah S Terkawi, MD, Sonal Sharma, MD, Marcel E Durieux, MD, PhD, and Swapna Thammishetti, MD.

BACKGROUND: Chronic post-surgical pain (CPSP) is a not uncommon complication after mastectomy, with a reported incidence between 20% and 68%. Careful dissection, the use of minimally invasive surgical techniques, and attempts to reduce the associated inflammatory and hyperalgesic responses are suggested methods to prevent CPSP. OBJECTIVE: To determine if the use of perioperative lidocaine infusion is associated with decreased incidence of CPSP after mastectomy. STUDY DESIGN: Double-blind, placebo-controlled randomized trial. METHODS: This is a secondary analysis of data from 61 out of 71 patients who underwent mastectomy for breast cancer. Patients were randomized to either placebo (Group P; n = 27) or intravenous lidocaine (Group L; n = 34, bolus 1.5 mg/kg at induction, then infusion at 2 mg/kg/hr, up to 2 hours after the end of surgery) in a prospective double-blind design. CPSP was assessed at 6 months after surgery. Stepwise logistic regression analysis was performed to assess the efficacy of lidocaine. RESULTS: Overall 12 (20%) patients developed CPSP, 8 (30%) in the placebo group and 4 (12%) in the lidocaine group. Predictive factors for CPSP that remained significant after multivariate analysis included lidocaine (associated with a 20-fold decrease in CPSP, P = 0.013), breast implant placement (associated with a 16-fold increase in CPSP, P = 0.034), and radiotherapy (associated with a 29-fold increase in CPSP, P = 0.008). LIMITATIONS: Small sample size. CONCLUSION: Perioperative lidocaine administration was associated with a decreased incidence of CPSP, while breast implant placement and radiotherapy were associated with an increased incidence. These findings suggest a protective effect of lidocaine on CPSP development in mastectomy patients.