Local anesthetic delivery via surgical drain provides improved pain control versus direct skin infiltration following axillary node dissection for breast cancer.

BACKGROUND: Axillary node dissection has a central role in the surgical management of breast cancer; however, it is associated with a significant risk of lymphoedema and chronic pain. Peri-operative administration of local anesthesia reduces acute and persistent post-surgical pain, but there is currently no consensus on the optimal method of local anesthetic delivery. METHODS: Patients undergoing axillary dissection for breast cancer were randomly assigned to receive a one-off dose of levobupivacaine 0.5% (up to 2 mg/kg) following surgery, either via the surgical drain or by direct skin infiltration. Post-operative pain control at rest and on shoulder abduction was assessed using a numerical rating scale. Total analgesia consumption 48 h after surgery was also recorded. RESULTS: Pain scores were significantly lower when local anesthesia was administered via surgical drain at both 3 and 12 h after surgery; this trend extended to 24 h post-operatively. However, pain scores on shoulder abduction did not differ at the 12 or 24 h time points. No differences were found in the total analgesia consumption or length of hospital stay between treatment groups. DISCUSSION: This study demonstrates that local anesthetic delivery via a surgical drain provides improved pain control compared to direct skin infiltration following axillary node dissection. This is likely to be important for the management of acute pain in the immediate post-operative period; however, further studies may be required to validate this in specific patient subgroups, e.g., breast-conserving surgery versus mastectomy.

Recurrent giant juvenile fibroadenomas with hemihypertrophy.

Giant juvenile fibroadenomas in patients with hemihypertrophy are exceptionally rare. We present a very interesting case of a 13 year old girl with hemihypertrophy of the left side presenting with recurrent giant juvenile fibroadenomas of the left breast. The giant fibroadenomas occurred twice in the left breast over two years. The first had a diameter of 12 cm and was excised through an inframammary incision. The second occurred a year later, had a diameter of 11 cm, and was associated with three smaller fibroadenomas. These lesions were removed through a single periareolar incision. The procedures were complicated by keloid scarring but the results were improved with steroid impregnated tape dressing and local methylprednisolone injection. This report adds to our experience in managing patients with recurrent giant juvenile fibroadenomas complicated by hemihypertrophy and raises awareness to anticipate keloid scarring.