Post-mastectomy and post-breast conservation surgery pain syndrome: a review of etiologies, risk prediction, and trends in management

Chen, Victor E.; Greenberger, Benjamin A.; Shi, Zhicai; Gajjar, S.; Shi, Wenyin; Mourad, W.F.; Yan, Weisi

doi:10.21037/tcr.2019.06.46

Cited by 12 publications

(10 citation statements)

References 68 publications

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“…In 2006, a study showed that youth was often considered a predictor of postoperative pain [39]. Recent studies also show that younger breast cancer patients are more likely to develop PMPS than older breast cancer patients [40][41][42]. In our study, patients in the PMPS group were also younger than those in the non-PMPS group.…”

Section: Agesupporting

confidence: 55%

See 1 more Smart Citation

Incidence, risk factors, prevention and treatment of postmastectomy pain syndrome in breast cancer: A multicenter study

Ren¹,

Kong²,

Yang³

et al. 2022

International Journal of Surgery

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Section: Agesupporting

confidence: 55%

“…According to the literature, the physical and psychological conditions before operation will affect the occurrence of PMPS [5,42,[84][85][86]. Preoperative pain is considered to be one of the risk factors of postoperative persistent pain.…”

Section: Physical and Psychological Conditionsmentioning

confidence: 99%

Incidence, risk factors, prevention and treatment of postmastectomy pain syndrome in breast cancer: A multicenter study

Ren¹,

Kong²,

Yang³

et al. 2022

International Journal of Surgery

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“…[ 13 14 ] During BCCS or mastectomy, injury to the intercostobrachial and intercostal nerves is usually unavoidable which leads to pain and discomfort. [ 15 ] Oral tramadol and pregabalin have been used as premedicants in other types of surgeries for controlling postoperative pain. Tramadol is being prescribed for treating acute and chronic pain as a substitute for the high affinity opioids, the world over.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the postoperative morphine-sparing effect of oral premedicants used as pre-emptive analgesics in breast-conserving cancer surgeries: A randomised placebo-controlled trial

Gupta

Pushkarna

Badhan

et al. 2022

Indian Journal of Anaesthesia

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Background and Aims: Breast cancer surgeries are associated with both nociceptive and neuropathic pain, requiring strong analgesics. We aimed to evaluate the postoperative morphine-sparing effect of pre-emptive oral premedication with tramadol versus pregabalin in patients undergoing breast-conserving cancer surgeries (BCCS). Methods: This prospective, randomised, placebo-controlled trial was carried out at tertiary care centre on 90 patients undergoing BCCS randomised into three groups of 30 each. Group C received placebo, Group T received tramadol 100 mg and Group P received pregabalin 75 mg as oral premedication, 1 hour before surgery. General anaesthesia was administered. Postoperatively morphine 1 mg.h -1 through intravenous PCA was started at a visual analogue scale score ≥4. Total morphine consumption in 24 hours was calculated and its sparing effect was evaluated as the primary outcome. Results: The median with interquartile range (IQR) of total postoperative morphine consumed in 24 hours, was found to be 22 mg (IQR 0-25.77), 15 mg (IQR 0-16) and 17.50 mg (IQR 0-19.25) in groups C, T, P respectively, (P = 0.000, 0.003, 0.060). The median duration of analgesia in group C was 5.40 hours (IQR 3.30-11.40), 11.6 hours (IQR 9.30-24.0) in group T and 8.60 hours (IQR 6.97-16.27) in group P (P value C/T = 0.000, C/P = 0.007, T/P = 0.002). The postoperative side effects were comparable. Conclusion: Oral tramadol 100 mg and oral pregabalin 75 mg as premedication reduced the 24 hours postoperative morphine requirement as compared to placebo in BCCS. However, tramadol 100 mg provided superior analgesia for longer duration than pregabalin 75 mg and was associated with more side effects.

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“…Modified radical mastectomy is one of the mainstay standard treatments 2 . However, most patients report a certain degree of postoperative pain, which can lead to more surgical complications, prolonged hospital stays, long‐term chronic postoperative pain, and reduced quality of life 3,4 . In addition, the stress from surgical procedures can cause inflammatory responses, with increased production and release of various cytokines, such as interleukin‐1β (IL‐1β) and IL‐6 5–7 .…”

Section: What Is Known and Objectivementioning

confidence: 99%

Analgesia and stress attenuation of ultrasound‐guided modified pectoral nerve block type‐II with different volumes of 0.3% ropivacaine in patients undergoing modified radical mastectomy for breast cancer: A prospective parallel randomized double‐blind controlled clinical trial

Lin

Cai

Chen

et al. 2022

Clinical Pharmacy Therapeu

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What Is Known and Objective A previous randomized clinical trial concluded that an optimal concentration of 0.3% ropivacaine could provide satisfactory analgesia for breast cancer patients undergoing modified radical mastectomy. We wondered if a smaller volume (30 ml vs. 40 ml) of 0.3% ropivacaine could still provide adequate analgesia in an ultrasound‐guided PECS II block in modified radical mastectomy. Methods We performed a prospective parallel randomized double‐blind controlled clinical trial. Eligible patients were assigned to either the P30 or P40 group (30 or 40 ml of 0.3% ropivacaine, respectively). The skin area of hypoesthesia, anaesthetic plane determined with ultrasound, pain visual analogue scale (VAS), anaesthetic dosages, and complications were recorded. Serum levels of interleukin‐1β and interleukin‐6 were measured postoperatively. Results and Discussion A total of 40 patients completed the trials, with 20 patients in each group. Although the skin area of hypoesthesia and the anaesthetic planes were significantly larger in the P40 group compared with the P30 group (p < 0.05), the VAS, analgesic and opioid doses, serum cytokine levels, anaesthetic toxicity, and complications had no significant differences between the two groups. What Is New and Conclusion Compared with 40 ml, 30 ml of 0.3% ropivacaine could provide adequate analgesia and reduce surgical stress in patients undergoing modified radical mastectomy for breast cancer.

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Post-mastectomy and post-breast conservation surgery pain syndrome: a review of etiologies, risk prediction, and trends in management

Cited by 12 publications

References 68 publications

Incidence, risk factors, prevention and treatment of postmastectomy pain syndrome in breast cancer: A multicenter study

Incidence, risk factors, prevention and treatment of postmastectomy pain syndrome in breast cancer: A multicenter study

Evaluation of the postoperative morphine-sparing effect of oral premedicants used as pre-emptive analgesics in breast-conserving cancer surgeries: A randomised placebo-controlled trial

Analgesia and stress attenuation of ultrasound‐guided modified pectoral nerve block type‐II with different volumes of 0.3% ropivacaine in patients undergoing modified radical mastectomy for breast cancer: A prospective parallel randomized double‐blind controlled clinical trial

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