Pain management after major oncological breast surgery: an updated systematic review and procedure specific postoperative pain management (PROSPECT) recommendations.
Neel Desai, Dan S Dirzu, Danaja Zolger et al.
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In 30 seconds
This PROSPECT systematic review updated recommendations for peri-operative pain management after major oncological breast surgery, assessing randomised controlled trials and systematic reviews. It included 176 randomised controlled trials and eight systematic reviews. The recommendations support paracetamol, nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors, dexamethasone, physiotherapy, and several single-shot regional analgesic techniques, which the review considers equivalent to one another. Gabapentin and continuous thoracic paravertebral block are no longer recommended.
Key findings
- The review included 176 randomised controlled trials and eight systematic reviews.
- Paracetamol, nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors, and dexamethasone remain recommended.
- Several single-shot regional techniques are recommended and considered equivalent; continuous thoracic paravertebral block is no longer recommended.
- Gabapentin is no longer recommended because of problematic adverse effects; pre- and postoperative physiotherapy is recommended.
Why it matters
The review consolidates evidence into procedure-specific guidance for a surgery associated with significant postoperative pain. It highlights a multimodal approach combining systemic analgesics, a single-shot regional technique and physiotherapy, while distinguishing these options from gabapentin and continuous paravertebral blockade, which are not recommended in the updated guidance.
What to keep in mind
The abstract does not report quantitative comparative effects for the recommended interventions, limiting assessment of the magnitude of benefit.