Background & Aim: In this randomized, controlled , double-blind study of wound instillation to compare  with different concentration of bupivacaine via surgical drain in patient undergoing modified radical mastectomy would reduce the postoperative acute pain and would reduce amount of rescue analgesics used in postoperative period. Aim of the study is to evaluate the efficacy of bupivacaine for analgesia with different concentration and provide economical, safe and good analgesia.

Material and Method: Ninety patient undergoing elective modified radical mastectomy were randomized in to 3 groups. Following placing the surgical drain, Group A received no instillation. Group B and C received bupivacaine 0.125 % and 0.25% instillation via surgical drains. Pain was assessed using visual analog scale at fixed time interval and other side effects were noted for next 24 hrs. Statistical analysis was done by using SPSS version 21, INDOSTAT statistical analysis software.

Observations: No significant difference were seen in analgesic duration with higher concentration dosage of bupivacaine. The median pain level postoperatively were 4+.5hr and 6+5hr in group B and C. (p value <0.001)

Conclusion: Higher concentration of Bupivacaine doesn’t significantly improve the duration of pain control. Instead of potential dose related risks.

Keywords: wound instillation, Bupivacaine (0.125% & 0.25%), Visual analogue scale (VAS).

1. Culliford AT 4th, Spector JA, Flores RL, Louie O, Choi M, Karp NS. Intraoperative Sensorcaine significantly improves postoperative pain management in outpatient reduction mammaplasty. Plast Reconstr Surg 2007; 120:840‑
2. Zielinski J1, Jaworski R, Smietanska I, Irga N, Wujtewicz M, Jaskiewicz J. A randomized, double-blind, placeco contro-lled trail of pre-emptive analgesia with bupivacaine in patients undergoing mastectomy for carcinoma of the breast. Med SciMonit. 2011 Oct; 17(10):CR589-97.
3. Lu TJ1, Chen JH, Hsu HM, Wu CT, Yu JC. Efficiency of infiltration with bupivacain after modified radical mastectomy. ActaChir Belg.2011 Nov-Dec; 111(6):360-3.
4. Ferreira Laso L1, López Picado A, Antoñanzas Villar F, Lamata de la Orden L, Ceballos Garcia M, IbañezLópez C, PipaonRuilope L, Lamata Hernandez F, Valero Martinez C, Aizpuru F, Hernandez Chaves R. Clin Drug Investig. Cost-effectiveness analysis of levobupivacaine 0.5 %, a local anesthetic, infusion in the surgical wound after modified radical mastectomy. 2015 Sep; 35(9):575-82. doi: 10.1007/s40261-015-0316-4.
5. Jonnavithula N1, Khandelia H1, Durga P1, Ramachandran G Role of wound instillation with bupivacaine through surgical drains for postoperative analgesia in modified radical mastectomy. Indian J Anaesth.2015 Jan; 59(1):15-20. doi: 10.4103/0019-5049.149443.
6. Dumlu EG, Tokae M, Oeal H. Local bupivacaine for postoperative pain management in the thyroidectomised patient: A prospective and controlled clinical study. Ulus CerrahiDerg. 2015;32(3):173-7
7. Kryger ZB1, Rawlani V, Lu L, Fine NA. Decreased postoperative pain, narcotic, and antiemetic use after breast reduction using a local anesthetic pain pump. Ann Plast Surg.2008 Aug; 61(2):147-52. doi: 10.1097/SAP.0b013e31815a23ef.
8. Altuntus G, Akkaya OT, Ozkan. Comparision of intraabdominal and trocar site local anaesthetic infiltration on postoperative analgesia after laparoscopic cholecystectomy. Turk J Aanaesthesiol Reanim 2016;10.5152/TJAR
9. Campbell I1, Cavanagh S, Creighton J, French R, Banerjee S, Kerr E, Shirley R. To infiltrate or not? Acute effects of local anaesthetic in breast surgery. ANZ J Surg.2015 May; 85(5):353-7.
10. Mahabir RC1, Peterson BD, Williamson JS, Valnicek SM, Williamson DG, East WE. Locally administered ketorolac and bupivacaine for control of postopera-tive pain in breast augmentation patients. Plast Reconstr Surg.2004 Dec; 114(7): 1910-6.

Dr Rajesh Kumar Meena