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Pain Management

Breast Cancer Pain Management 

It’s no surprise that untreated or excess pain significantly interferes with a person’s recovery after surgery.  Paul Dangerfield, MD is director of Clinical Anesthesia at The GW Medical Faculty Associates.  Fourteen years ago he saw breast cancer patients in a lot of pain and thought there had to be a better way.  Motivated by those patients, and by his own wife’s experience, Dr. Dangerfield set out to devise a better, less-painful approach. His methodology of choice is the conventional paravertebral block (PVB). It’s a long-standing local anesthetic approach enjoying a renaissance among breast care patients. PVB is effective in alleviating pain associated with breast care treatment during procedures ranging from simple biopsies to complex mastectomies with reconstruction.  Leading a team of physicians and nurses working in the George Washington University Hospital’s Acute Pain Service, Dr. Dangerfield brings unparalleled pain management expertise to the Comprehensive Breast Care Program at The GW Medical Faculty Associates.  

PVB reduces both short and long term pain. This nerve block delivers numbing medication directly to the affected area, and therefore has fewer side effects than stronger, narcotic medications, and it’s long lasting.  Patients using PVB report feeling well the day after surgery— though some report experiencing some minor aching and fatigue.

It takes time for patients facing surgery to come up with a battery of questions and concerns, have those questions answered, and then feel comfortable about going home with a pump, drains and a catheter, no matter the benefits and the record of success.  Still there are distinct benefits for patients who opt to undergo PVB as an option for surgical pain management.

Advantages of PVB:

  • PVBs have been shown to reduce chronic pain after breast and thoracic surgery.
  • PVB can be performed safely in fully anaesthetized patients.
  • There is less sedation, nausea, vomiting, and constipation compared with opioid-based analgesic techniques, as opioid consumption is considerably reduced.
  • There is less risk of neurological complications than with most other regional anesthetic techniques.

 

The Comprehensive Breast Care Program at The GW Medical Faculty Associates and the Acute Pain Service at The George Washington University Hospital employ multi-modal pain control strategies which help manage post-operative pain and post-traumatic pain, including:

  • Paravertebral block—Injection of local anesthetic next to the nerves as the nerves exit from the spinal canal. A small catheter may be placed to continuously infuse local anesthetic to the thoracic or lumbar region of the back. This can be done for inpatients or outpatients.
  • Multimodal medication management—A combination of pain relief medications, each of which act in a different way, to help control pain.
  • Patient controlled analgesia (PCA)—Allows patients to independently and safely self-administer pain medication as needed through an intravenous catheter.
  • Peripheral nerve blocks—Injection of local anesthetic next to a patient’s nerve in their arms or legs to reduce pain. A small catheter may be placed to continuously infuse local anesthetic. This can be done for inpatients or outpatients.
  • Epidural analgesia—Administration of local anesthetics continuously infused through a small catheter placed in the epidural space in the body, or the space inside the spinal canal.
  • Patient controlled epidural analgesia (PCEA)—Allows patients to independently control delivery of pain medication that is administered via a catheter placed in the epidural space.
  • Ketamine infusion therapy—An analgesic, administered intravenously in low dosages over a period of several days to manage pain. 

The Team

The Acute Pain Service team consists of attending anesthesiologists, anesthesiology residents and registered nurses. The team uses its exceptional range of skills, training, experience and knowledge to evaluate each patient’s needs and develop individualized treatment plans.