Technique and efficacy of pain control after major breast surgery in Srinagarind Hospital
Keywords:
major breast surgery, breast cancer, pain control, post operative painAbstract
The incidence of breast cancer has increased over the years, and breast surgery remains the mainstay treatment. Effective acute postoperative pain management has a significant impact on the quality of life. This study aims to evaluate efficacy of pain control management after major breast surgery in Srinagarind hospital. This retrospective descriptive study was approved by the institutional ethics committee; we extracted data from patients who underwent major breast surgery between January 1, 2020, and December 31, 2022. Patients aged over 18 years and ASA physical status of I-III were included. Patients who underwent bilateral breast surgery, breast reconstruction, and incomplete anesthetic records were excluded. Patient demographic data, type of surgeries, anesthetic techniques, postoperative pain scores, cumulative opioid requirements, and opioid-related complications were collected in the study. From this study, 302 out of the 523 patients met the inclusion criteria. All the patients were female, with 53.6% undergoing modified radical mastectomy and 85.4% receiving general anesthesia (GA) alone for surgery. None to mild pain at the Post-Anesthesia Care Unit (PACU) was reported by 51.9% of patients. Combining GA with any regional anesthesia (RA) technique significantly reduces the incidence of severe pain in the PACU. More than 46% of patients who had GA alone reported severe pain, but only 31.8% who had both GA and RA together (p-value=0.036). From this study, over half of the patients undergoing major breast surgery in our hospital experience adequate pain control. The combination of RA with the GA technique improves the acute postoperative pain relief.
References
Youn HJ, Han W. A review of the epidemiology of breast cancer in Asia: focus on risk factors. Asian Pac J Cancer Prev 2020;21(4):867-80. doi:10.31557/APJCP.2020.21.4.867
Lepot A, Elia N, Tramèr MR, et al. Preventing pain after breast surgery: a systematic review with meta-analyses and trial-sequential analyses. Eur J Pain 2021;25(1):5-22. doi:10.1002/ejp.1648
Al-Hilli Z, Wilkerson A. Breast surgery: Management of postoperative complications following operations for breast cancer. Surg Clin North Am 2021;101(5):845-63. doi:10.1016/j.suc.2021.06.014
Fecho K, Miller NR, Merritt SA, et al. Acute and persistent postoperative pain after breast surgery. Pain Med 2009;10(4):708-15. doi:10.1111/j.1526-4637.2009.00611.x
Wang L, Cohen JC, Devasenapathy N, et al. Prevalence and intensity of persistent post-surgical pain following breast cancer surgery: a systematic review and meta-analysis of observational studies. Br J Anaesth 2020;125(3):346-57. doi:10.1016/j.bja.2020.04.088
Schreiber KL, Zinboonyahgoon N, Flowers KM, et al. Prediction of persistent pain severity and impact 12 months after breast surgery using comprehensive preoperative assessment of biopsychosocial pain modulators. Ann Surg Oncol 2021;28(9):5015-38. doi:10.1245/s10434-020-09479-2. Erratum in: Ann Surg Oncol 2021;28(Suppl 3):896. doi:10.1245/s10434-021-10658-y.
Cheng GS, Ilfeld BM. A review of postoperative analgesia for breast cancer surgery. Pain Manag 2016;6(6):603-18. doi:10.2217/pmt-2015-0008
Wang K, Yee C, Tam S, et al. Prevalence of pain in patients with breast cancer post-treatment: a systematic review. Breast 2018;42:113-27. doi:10.1016/j.breast.2018.08.105
Jacobs A, Lemoine A, Joshi GP, et al. PROSPECT guideline for oncological breast surgery: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2020;75(5):664-73. doi:10.1111/anae.14964
Steegers MA, Wolters B, Evers AW, et al. Effect of axillary lymph node dissection on prevalence and intensity of chronic and phantom pain after breast cancer surgery. J Pain 2008;9(9):813-22. doi:10.1016/j.jpain.2008.04.001
Schreiber KL, Belfer I, Miaskowski C, et al. AAAPT diagnostic criteria for acute pain following breast surgery. J Pain 2020;21(3-4):294-305. doi:10.1016/j.jpain.2019.08.008
Costa F, Strumia A, Remore LM, et al. Breast surgery analgesia: another perspective for PROSPECT guidelines. Anaesthesia 2020;75(10):1404-5. doi:10.1111/anae.15161
Gürkan Y, Aksu C, Kuş A, et al. Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: a randomized controlled trial. J Clin Anesth 2020;59:84-8. doi:10.1016/j.jclinane.2019.06.036
Bakeer A, Abdallah NM. Erector spinae plane block versus PECS block type II for breast surgery: a randomized controlled trial. Anesth Pain Med 2022;12(2):e122917. doi:10.5812/aapm-122917
Zhang Y, Liu T, Zhou Y, et al. Analgesic efficacy and safety of erector spinae plane block in breast cancer surgery: a systematic review and meta-analysis. BMC Anesthesiol 2021;21(1):59. doi:10.1186/s12871-021-01277-x
Hussain N, Brull R, Noble J, et al. Statistically significant but clinically unimportant: a systematic review and meta-analysis of the analgesic benefits of erector spinae plane block following breast cancer surgery. Reg Anesth Pain Med 2021;46(1):3-12. doi:10.1136/rapm-2020-101917
Liu XN, Noh YM, Yang CJ, et al. Effects of a single-dose interscalene block on pain and stress biomarkers in patients undergoing arthroscopic rotator cuff repair: a randomized controlled trial. Arthroscopy 2017;33(5):918-26. doi:10.1016/j.arthro.2016.09.018
de Arzuaga CIS, Miguel M, Biarnés A, et al. Single-injection nerve blocks for total knee arthroplasty: femoral nerve block versus femoral triangle block versus adductor canal block—a randomized controlled double-blinded trial. Arch Orthop Trauma Surg 2023;143(11):6763-71. doi:10.1007/s00402-023-04960-5
Schnabel A, Reichl SU, Kranke P, et al. Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trials. Br J Anaesth 2010;105(6):842-52. doi:10.1093/bja/aeq265. Erratum in: Br J Anaesth 2013;111(3):522.
Ardon AE, Lee J, Franco CD, et al. Paravertebral block: anatomy and relevant safety issues. Korean J Anesthesiol. 2020;73(5):394-400. doi:10.4097/kja.20065
Moore CC, Dickerson DM. Pneumothorax after paravertebral block and radiofrequency. In: Anitescu M, Benzon H, Wallace M, editors. Challenging cases and complication management in pain medicine. Cham: Springer; 2018.
Forero M, Adhikary SD, Lopez H, et al. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016;41(5):621-7. doi:10.1097/AAP.0000000000000451.
Blanco R. The ‘pecs block’: A novel technique for providing analgesia after breast surgery. Anaesthesia 2011;66(9):847-8. doi:10.1111/j.1365-2044.2011.06838.x
Hamilton DL, Pawa A. Anaesthesia for awake breast surgery. BJA Educ 2022;22(12):452-5.
Putte P, Blockmans D, Rop C, et al. Pectoral nerve block type II as the sole anesthetic for removal of a large axillary tumor: a case report. A A Pract 2020;14:e01201. doi:10.1016/j.bjae.2022.08.003
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Journal of Medicine and Health Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
