Advantages of wound instillation of local anaesthetic drug mixture along with an additive through surgical drains (drain block) for postoperative analgesia after Modified Radical Mastectomy: A case series

The aim of this study is to report six cases of Drain Block for postoperative analgesia after Modified Radical Mastectomy (MRM). The procedure was carried out at Chittaranjan National Cancer Institute, Kolkata, among 6 female patients aged 32-75 years, who were diagnosed with unilateral breast carcinoma and were posted for MRM. Upon completion of MRM, all patients received a 40 ml solution of local anaesthetic drug mixture comprising of 0.5% isobaric bupivacaine (2 mg/kg) and 2% lignocaine (4 mg/kg) along with 2 ml of 50% Magnesium sulphate as an additive. The 40 ml solution was equally divided and instilled through both the surgical drains (pectoral and axillary drains). Thereafter, the drains were then clamped for 20 minutes and later declamped. The postoperative analgesic outcome was measured in terms of pain and mobility. Pain was quantified with VAS, while mobility was assessed using the evaluation of range of motion with the help of bio-physiological method. The documentation was carried out every 4 hours and continued for twenty-four hours postoperatively. No patient required rescue opioids for the first 18 postoperative hours, with 2 patients having no requirements (VAS < 4) for the first 22 postoperative hours. There were no limitations in ipsilateral arm abduction in immediate postoperative hours in any of the patients. Drain block, combining the beneficial effect of lignocaine on disease free survival in oncology patients and its potency to reduce dependence on postoperative opioids requirements, might prove to be a game changer by comprehensively covering all significant aspects of postoperative analgesia after MRM.