Preemptive analgesia with bupivacaine in reduction mammaplasty: a prospective, randomized, double-blind, placebo-controlled trial.

[BACKGROUND] Preincisional analgesia is an antinociceptive treatment that prevents altered central excitability from high-intensity noxious stimuli. To determine the analgesic efficacy of preoperative infiltration with bupivacaine for reduction mammaplasty, a randomized, double-blind, placebo-controlled trial was designed.

[METHODS] Women with mammary hypertrophy were allocated randomly to one of two study groups. Patients in group I received preincision infiltration with bupivacaine into each breast after general anesthesia. Group II patients received similar injections of saline injection alone after general anesthesia.

[RESULTS] Visual analogue pain score, verbal pain score, and short-form McGill Pain Questionnaire scores were higher in group II patients until 22 hours after surgery (p < 0.008). Patients in the saline group had higher intravenous meperidine consumption for 22 hours postoperatively and solicited opioids before the patients in the bupivacaine group (p < 0.001). The difference between groups was statistically significant.

[CONCLUSION] Preincisional infiltration with bupivacaine results in reduced pain and lower postoperative opioid requirements in the early postoperative phase of pain following breast reduction.

[CLINICAL QUESTION/LEVEL OF EVIDENCE] Therapeutic, I.