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Research article
Pasquale Sansone
Universita degli Studi della Campania Luigi Vanvitelli
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0873-3586
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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.
Keywords
breast surgery, mastabreast surgery, mastectomy, locoregional anesthesia, pain intensity, opioid consumption, adverse events, patient satisfaction.ectomy, locoregional anesthesia, pain intensity, opioid consumption, adverse events, patient satisfaction
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View the published article at BMC Anesthesiology.
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On 31 Oct, 2020
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On 31 Oct, 2020
No comments provided
Editorial decision: Major revision
On 19 Oct, 2020
Review #2 received
Received 01 Oct, 2020
Reviewer #2 agreed
On 11 Sep, 2020
Reviewers invited
Invitations sent on 08 Sep, 2020
Reviewer #1 agreed
On 08 Sep, 2020
Review #1 received
Received 08 Sep, 2020
Editor assigned
On 01 Sep, 2020
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On 31 Aug, 2020
Editor invited
On 31 Aug, 2020
Version (no preprint)
Posted 03 Sep, 2020
Editor assigned
On 26 Oct, 2020
Reviewers invited
Invitations sent on 26 Oct, 2020
Reviewer #1 agreed
On 26 Oct, 2020
Review #1 received
Received 26 Oct, 2020
Submission checks complete
On 25 Oct, 2020
Editor invited
On 25 Oct, 2020
This version was not preprinted
No comments provided
Editorial decision: Major revision
On 23 Jul, 2020
Review #3 received
Received 20 Jul, 2020
Reviewer #2 agreed
On 22 Jun, 2020
Reviewer #3 agreed
On 22 Jun, 2020
Review #2 received
Received 22 Jun, 2020
Review #1 received
Received 20 Jun, 2020
Reviewers invited
Invitations sent on 09 Jun, 2020
Reviewer #1 agreed
On 09 Jun, 2020
Editor assigned
On 28 May, 2020
First submitted
On 27 May, 2020
Submission checks complete
On 27 May, 2020
Editor invited
On 27 May, 2020
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Subject Areas
Anesthesiology & Pain Medicine
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A new preprint design is coming!
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See the published version of this preprint at BMC Anesthesiology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Pasquale Sansone
Universita degli Studi della Campania Luigi Vanvitelli
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0873-3586
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Anesthesiology.
No community comments so far
Submission checks complete
On 20 Nov, 2020
Editorial decision: Accept
On 15 Nov, 2020
Version 3
Posted 06 Nov, 2020
No comments provided
Editorial decision: Major revision
On 02 Nov, 2020
Editor assigned
On 31 Oct, 2020
Submission checks complete
On 31 Oct, 2020
Editor invited
On 31 Oct, 2020
No comments provided
Editorial decision: Major revision
On 19 Oct, 2020
Review #2 received
Received 01 Oct, 2020
Reviewer #2 agreed
On 11 Sep, 2020
Reviewers invited
Invitations sent on 08 Sep, 2020
Reviewer #1 agreed
On 08 Sep, 2020
Review #1 received
Received 08 Sep, 2020
Editor assigned
On 01 Sep, 2020
Submission checks complete
On 31 Aug, 2020
Editor invited
On 31 Aug, 2020
Version (no preprint)
Posted 03 Sep, 2020
Editor assigned
On 26 Oct, 2020
Reviewers invited
Invitations sent on 26 Oct, 2020
Reviewer #1 agreed
On 26 Oct, 2020
Review #1 received
Received 26 Oct, 2020
Submission checks complete
On 25 Oct, 2020
Editor invited
On 25 Oct, 2020
This version was not preprinted
No comments provided
Editorial decision: Major revision
On 23 Jul, 2020
Review #3 received
Received 20 Jul, 2020
Reviewer #2 agreed
On 22 Jun, 2020
Reviewer #3 agreed
On 22 Jun, 2020
Review #2 received
Received 22 Jun, 2020
Review #1 received
Received 20 Jun, 2020
Reviewers invited
Invitations sent on 09 Jun, 2020
Reviewer #1 agreed
On 09 Jun, 2020
Editor assigned
On 28 May, 2020
First submitted
On 27 May, 2020
Submission checks complete
On 27 May, 2020
Editor invited
On 27 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Anesthesiology.
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.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
This is a list of supplementary files associated with this preprint. Click to download.
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