The Effects of Anesthetics on Persistent Pain Following Breast Cancer Surgery

Study Overview
=================
Brief Summary
-----------------
Persistent postoperative pain occurs up to 25 to 60 % after mastectomy. This occurs at a higher frequency than the rate of invasive surgery.Therefore, many ways have been tried to study risk factors. A study was conducted to predict postoperative pain for items (preoperative pain, sensitivity, pain prediction). As a result, it was reported that the scope of surgery, pre-operative pain, young age, and depression were associated with persistent pain. This study try to find out whether persistent pain after mastectomy is affected anesthetic factors appropriate anesthesia depth and opioid using standardized monitoring devices limited to similar surgical ranges.

Detailed Description
-----------------
Persistent postoperative pain occurs up to 25 to 60 % after mastectomy. This occurs at a higher frequency than the rate of invasive surgery.Therefore, many ways have been tried to study risk factors. A study was conducted to predict postoperative pain for items (preoperative pain, sensitivity, pain prediction). As a result, it was reported that the scope of surgery, pre-operative pain, young age, and depression were associated with persistent pain. There were reports of no association with anesthesia in the area of anesthesia to the high pain control requirement in the postoperative recovery room, 24 hours of high pain medication, use of inhalation agent, and a high dosage of remifentanil. However, an anesthesia-related study was either a retrospective study or anesthetic was injected with more than a clinical dose in order to make the difference following methods. In this study, bispectral index is used to maintain anesthesia depth. In addition, the commercially available noninvasive pain depth equipment (Surgical Pleth Index) is used to assess the nociception-antinociception balance. Displays the automatically calculated values of SPI=100-(0.3*heartbeat interval + 0.7*photoplethysmographic pulse wave ampule) using a waveform with peripheral oxygen saturation. Through this process, patients want to objectify the amount of anesthetic agent used during surgery. And all patients are inserted the laryngeal mask airway. This study would try find out whether persistent pain after mastectomy is affected anesthetic factors appropriate anesthesia depth and opioid using standardized monitoring devices limited to similar surgical ranges. The investigators hypothesize that patients who suffered severe acute postoperative pain, regardless of their anesthesia method, have a higher incidence of persistent post-mastectomy pain.

Official Title
-----------------
The Effects of Anesthetics on Persistent Pain Following Breast Cancer Surgery

Conditions
-----------------
Breast Cancer, Chronic Post-Procedural Pain

Intervention / Treatment
-----------------
* Other: acute postoperative pain


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: -undergoing breast conserving surgery + sentinel lymph node dissection Exclusion Criteria: cardiac arrythmia allergic history for drugs renal failure (Cr> 1.5 mg/dl) performing axillary lymph node dissection or Total mastectomy difficult airway and failed to place laryngeal mask airway properly

Ages Eligible for Study
-----------------
Minimum Age: 20 Years
Maximum Age: 70 Years

Sexes Eligible for Study
-----------------
Female

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| mastectomy group<br>All patients who received the mastectomy (breast conserving surgery and sentinel lymph node dissection) | Other: acute postoperative pain<br>* All patients assessed postoperative pain score in the recovery room and postoperative 2 month<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| persistent pain | persistent postoperative pain after mastectomy (Numeric rating pain score (NSR: no pain=1, worst pain=10) | postoperative 2 months | 
| acute postoperative pain | acute postoperative pain in the recovery room measured by Numeric rating pain score (NSR: no pain=1, worst pain=10) | postoperative 1 hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| inhalation agent | inhalation anesthetics use or total intravenous anesthesia | intraoperative | 
| opioid consumption | the amount of opioid | intraoperative | 
| surgical anxiety level | (0: not anxiety-100: extremely anxious) | 1 day before surgery | 
| anticipate pain | (0: no pain-100: a bad as you can imagine) | 1 day before surgery | 
| anticipated pain medication need | (0: none at all, 1: much less than average, 2: less than average, 3: average, 4: more than average, 5: much more than average) | 1 day before surgery | 
| surgery factor | the incision size and the number of excision of lymph node | intraoperative | 
| The surgical pleth index | the highest surgical pleth index score in time of start anesthesia and ene of anesthesia | intraoperative | 
| The pain score of discharge | Numeric rating pain score (NSR: no pain=1, worst pain=10) | on the 1 day of discharge | 
| the consumption of postoperative analgesia | the consumption of postoperative analgesia during in-hospital day | postoperative 72 hours |