Glavas Tahtler Josipa, Djapic Dajana, Neferanovic Marina, Miletic Jelena, Milosevic Marta, Kralik Kristina, Neskovic Nenad, Tomas Ilijan, Mesaric Dora, Marjanovic Ksenija, Rajc Jasmina, Orkic Zelimir, Cicvaric Ana, Kvolik Slavica
Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia.
Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia.
Pharmaceutics. 2023 Aug 23;15(9):2183. doi: 10.3390/pharmaceutics15092183.
Breast cancer is the most common malignant disease in women. Preclinical studies have confirmed that the local anesthetic levobupivacaine has a cytotoxic effect on breast cancer cells. We examined whether postoperative wound infiltration with levobupivacaine influences survival in 120 patients who were operated on for breast cancer and underwent quadrantectomy or mastectomy with axillary lymph node dissection. Groups with continuous levobupivacaine wound infiltration, bolus wound infiltration, and diclofenac analgesia were compared. Long-term outcomes examined were quality of life, shoulder disability, and hand grip strength (HGS) after one year and survival after 5 and 10 years. Groups that had infiltration analgesia had better shoulder function compared to diclofenac after one year. The levobupivacaine PCA group had the best-preserved HGS after 1 year ( = 0.022). The most significant predictor of the 5-year outcome was HGS ( = 0.03). Survival at 10 years was 85%, 92%, and 77% in the diclofenac, levobupivacaine bolus, and levobupivacaine PCA groups (ns. = 0.36). The extent of the disease at the time of surgery is the most important predictor of long-term survival ( = 0.03). A larger prospective clinical study could better confirm the effect of levobupivacaine wound infiltration on outcomes after breast cancer surgery observed in this pilot study-trial number NCT05829707.
乳腺癌是女性中最常见的恶性疾病。临床前研究已证实，局部麻醉药左旋布比卡因对乳腺癌细胞具有细胞毒性作用。我们研究了左旋布比卡因术后伤口浸润是否会影响120例接受乳腺癌手术并进行象限切除术或乳房切除术加腋窝淋巴结清扫术患者的生存率。对持续左旋布比卡因伤口浸润组、大剂量伤口浸润组和双氯芬酸镇痛组进行了比较。所检查的长期结果包括一年后的生活质量、肩部功能障碍和握力（HGS），以及5年和10年后的生存率。一年后，与双氯芬酸组相比，浸润镇痛组的肩部功能更好。左旋布比卡因PCA组在1年后握力保持最佳（P = 0.022）。5年预后的最显著预测因素是握力（P = 0.03）。双氯芬酸组、左旋布比卡因大剂量组和左旋布比卡因PCA组10年生存率分别为85%、92%和77%（无显著性差异，P = 0.36）。手术时疾病的程度是长期生存的最重要预测因素（P = 0.03）。一项更大规模的前瞻性临床研究可以更好地证实本初步研究中观察到的左旋布比卡因伤口浸润对乳腺癌手术后预后的影响——试验编号NCT05829707。
