What is the role of locoregional anesthesia in breast surgery? A systematic literature review focused on pain intensity, opioid consumption, adverse events, and patient satisfaction

Abstract

Background Breast surgery in the United States is common. Pain affects up to 50% of women undergoing breast surgery and can interfere with postoperative outcomes. General anesthesia is the conventional, most frequently used anaesthetic technique. Various locoregional anesthetic techniques are also used for breast surgeries. A systematic review of the use of locoregional anesthesia for postoperative pain in breast surgery is needed to clarify its role in pain management. Objectives To systematically review literature to establish the efficacy and the safety of locoregional anesthesia used in the treatment of pain after breast surgery. Methods Embase, MEDLINE, Google Scholar and Cochrane Central Trials Register were systematically searched in Mars 2020 for studies examining locoregional anesthesia for management of pain in adults after breast surgery. The methodological quality of the studies and their results were appraised using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and specific measurement properties criteria, respectively. Results Nineteen studies evaluating locoregional anesthesia were included: 1058 patients underwent lumpectomy/mastectomy, 142 breast augmentation and 79 breast reduction. Locoregional anesthesia provides effective anesthesia and analgesia in the perioperative setting, however no statistically significant difference emerged if compared to other techniques. For mastectomy only, the use of locoregional techniques reduces pain in the first hour after the end of the surgery if compared to other procedures (p = 0.02). Other potentially beneficial effects of locoregional anesthesia include decreased need for opioids, decreased postoperative nausea and vomiting, fewer complications and increased patient satisfaction. All this improves postoperative recovery and shortens hospitalization stay. In none of these cases, locoregional anesthesia was statistically superior to other techniques. Conclusion The results of our review showed no differences between locoregional anesthesia and other techniques in the management of breast surgery. Locoregional techniques are superior in reducing pain in the first hour after mastectomy.

Efficacy of PECS block in addition to multimodal analgesia for postoperative pain management in patients undergoing outpatient elective breast surgery: A retrospective study

“…Conversely, some authors have reported similar results to our study, in which the use of PECS block did not significantly reduce perioperative opioid use when compared to MMA alone ( 29 , 47 , 48 ). A dual-centered, placebo-controlled RCT performed by Cros et al .…”

“…The fact that opioid consumption in our study was comparable between groups most likely did not allow for a significant inter-group difference in PONV. Several clinical studies and meta-analysis showing a significant impact of PECS blocks on opioid consumption have reported a marked reduction in PONV frequency when compared with control groups or with MMA regimens without peripheral nerve block ( 19 , 26 , 28 , 30 , 31 , 45 , 48 ).…”

The effect of ultrasound-guided erector spinae plane block combined with dexmedetomidine for postoperative pain management in lumbar spine surgery: A case-based discussion

“…US-ESPB can be useful as a safe and effective method for regional analgesia. It may improve postoperative recovery, shortens hospitalization stay and determinate an opioidsparing effect (14,15).…”

Hemodynamic Function in Comparison of Two Types of Local Anesthesia with Vasoconstrictor in Day Surgery: Retrospective Study

“…Hemodynamic changes and cardiac arrhythmias are not uncommon in clinical practice, depending on including patient features, surgical treatment and drugs administered (1,2). Management in the day surgery clinic is challenging because of fluctuating blood pressures and heart rates, and an attentive approach is required to avoid complications during day plastic surgical treatment (3,4,5,6,7). Local infiltration anesthesia (LIA) with local anesthetic T. Bagatin et al Effect of local infiltration analgesia on hemodynamic function in different surgical procedures in day surgery solutions contains vasoconstrictors that are commonly used and may potentially affect the cardiovascular condition (8).…”