Question

Discuss the post-operative pain management modalities in a 58-year-old female with carcinoma right breast planned for modified radical mastectomy.

Hint:

Use a multi-modal approach to pain management, combining opioids, non-opioids, regional blocks, and adjuncts to improve patient comfort and reduce opioid-related side effects.

Answer 1

Step 1: Pain Assessment.
The first step in post-operative pain management is assessing the patient's pain level using a standardized pain scale. This helps determine the appropriate analgesia approach. A 58-year-old female undergoing modified radical mastectomy is likely to experience both somatic and visceral pain, necessitating a multi-modal pain management approach.

Step 2: Opioid and Non-Opioid Analgesia.
- Opioids: Drugs like morphine or fentanyl are commonly used for moderate to severe pain. These can be administered via patient-controlled analgesia (PCA) or IV infusion for consistent pain relief.
- Non-opioid analgesics: NSAIDs like ibuprofen or paracetamol can be used for mild pain and as adjuncts to reduce opioid consumption and minimize side effects such as nausea and sedation.

Step 3: Regional Anaesthesia.
Regional anaesthesia, particularly a thoracic paravertebral block or epidural analgesia, can be very effective in managing pain following a modified radical mastectomy. These blocks provide excellent pain relief, especially in the first 24-48 hours post-surgery, and help reduce opioid use.

Step 4: Adjunctive Therapies.
- Local anaesthetics: Injecting local anaesthetics at the surgical site can help manage pain during the early post-operative period. - Gabapentinoids: Medications like gabapentin can be used for neuropathic pain management, especially if nerve injury occurs during surgery. - Cryotherapy: Applying cold packs to the surgical site can help reduce pain and swelling.

Step 5: Conclusion.
Post-operative pain management in breast cancer surgery involves a combination of opioids, non-opioids, regional anaesthesia, and adjunctive therapies. The goal is to provide adequate pain relief while minimizing side effects, allowing the patient to recover as comfortably as possible.