The effect of multimodal balanced anaesthesia and long term gabapentin on neuropathic pain, nitric oxide and interleukin-1β following breast surgery

Abstract

AbstractObjectivesTo evaluate the effect of multimodal balanced anaesthesia and gabapentin (6months) on neuropathic pain qualities, nitric oxide (NO) and interleukin 1-beta (IL-1β).MethodologyThis randomized study was conducted on 50 women scheduled for conservative breast surgery for cancer followed by chemotherapy and/or radiotherapy. Women enrolled into two groups; either to receive balanced general anaesthesia (GA) (control group) or ultrasound guided thoracic paravertebral with GA, multimodal balanced anaesthesia, (intervention group). Nociceptive pain was evaluated for 24h. Neuropathic pain was evaluated using pain questionnaire 1month postoperatively and neuropathic pain scale at 1, 3, 6 and 9months. Gabapentin was prescribed to women reporting neuropathic pain 1month postoperatively and for 6months. NO and IL-1β were measured before operation, 1, 3, 6 & 9months, postoperatively. Their relationship with neuropathic pain was assessed.ResultsNociceptive pain was less in intervention group than control group immediately post operative, 4h after surgery at rest and 8h with movement. Neuropathic pain started few days postoperatively, in both groups. Its onset, sites, duration and precipitating factors did not differ between the groups. Sensitive, hot pain and unpleasantness reduced significantly 1month postoperatively, in intervention group. Two months later, itchy, dull and sharp pain was significantly less in intervention group. At 6months, most of neuropathic pain items except sharp and deep pain lowered significantly in intervention group. At 9months, hot and superficial pain was still less in intervention group. NO decreased significantly 1 and 3months postoperatively, while IL-1β was significantly lower through different times, in intervention group. IL-1β correlated well with neuropathic pain intensity and unpleasantness.ConclusionBreast surgery for cancer was associated with neuropathic pain that continued for 9months after surgery. Multimodal balanced GA had positive impact on acute nociceptive and neuropathic pain. Gabapentin reduced almost all neuropathic pain qualities