Background and Aims Anesthesia and analgesia for surgery during pregnancy has focused on avoiding teratogenic drugs, preserving intrauterine homeostasis, and decreasing the risk of preterm labor. Data on the use of regional techniques and on patient preferences are still scarce. Based on a clinical case, we aimed to explore the patient experience of analgesia for oncologic breast surgery during pregnancy.
Methods A 19-weeks-pregnant 40-year-old woman with a diagnosis of breast cancer presented for mastectomy and sentinel lymph node biopsy. After discussion with the patient, an analgesia plan of post-induction pectoral type-2 block, acetaminophen, low-dose morphine, and postoperative acetaminophen, tramadol and prn metamizole was chosen. Acetaminophen and prn metamizole were prescribed home. Patient experience was elicited during the perioperative care and in a semi-structured interview at four-months.
Results On the first postoperative day, the patient reported only mild pain on movement and declined analgesia except for one administration of acetaminophen. After discharge, she reported significant pain on the surgical drain site. Until drain removal on the fourth postoperative day, she took acetaminophen and one prn metamizole. The main themes identified in the patient experience were a prioritization of fetal wellbeing, a concern for the effect of analgesic drugs on the fetus, and apprehension regarding nausea and sedation.
Conclusions Outcomes commonly measured in medical research are ultimately surrogates for outcomes that are more relevant to patients. This case suggests that a decreased need for analgesics may be more important to some patients than the absence of pain. Selected single-shot regional techniques are potentially useful in attaining this outcome.
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