Evaluation of pre-emptive mastectomy flap infi ltration with bupivacaine adrenaline

Objective: Postmastectomy pain is responsible for distress with subsequent organ dysfunction. Systemic analgesics such as opioids are not free of complications. The idea of preincisional mastectomy flap infiltration with bupivacaine and adrenaline was shown by many reports to decrease the postmastectomy pain and analgesic requirements. The aim of this study was to prove this with the assessment of the stress-response changes. Patients and methods: A total of 120 females who were candidates for mastectomy were randomized into an equal two groups using computer-generated random numbers; first was the study group in which the mastectomy flap was infi ltrated before skin incision with bupivacaine and adrenaline, whereas the second was a control. Assessment of patient and operative data was done. Results: There was no statistical difference between both groups regarding the demographic data, the tumor pathological data, hospital stay, and overall complications. The mean operative time was signifi cantly longer in the study group (P = 0.01). The mean blood loss was significantly less in the study group (P = 0.001). The mean postoperative arterial blood pressure and pulse were significantly less in the study group (P = 0.004 and 0.04, respectively). The mean intraoperative fentanyl and mean postoperative nalbuphine requirements were significantly less in the study group (P = 0.007 and 0.002, respectively). Visual analogue scale was significantly less in the study group (P = 0.01). Conclusion: Pre-emptive mastectomy flap infiltration with bupivacaine adrenaline solution is a safe and effective method for reduction of postmastectomy pain and stress response with a significant reduction of the analgesic requirements.