A Review of Postoperative Analgesia for Breast Cancer Surgery

Abstract

An online database search with subsequent article review was performed in order to review the various analgesic modalities for breast cancer surgery. Of 514 abstracts, 284 full-length manuscripts were reviewed. The effect of pharmacologic interventions is varied (NSAIDS, opioids, anticonvulsants, ketamine, lidocaine). Likewise, data from high-quality randomized, controlled studies on wound infiltration (including liposome encapsulated) and infusion of local anesthetic are minimal and conflicting. Conversely, abundant evidence demonstrates paravertebral blocks and thoracic epidural infusions provide effective analgesia and minimize opioid requirements, while decreasing opioid-related side effects in the immediate postoperative period. Other techniques with promising – but extremely limited – data include cervical epidural infusion, brachial plexus, interfascial plane and interpleural blocks. In conclusion, procedural interventions involving regional blocks are more conclusively effective than pharmacologic modalities in providing analgesia to patients following surgery for breast cancer.

KEYWORDS:

• breast cancer
• mastectomy
• paravertebral
• postoperative pain
• thoracic epidural

Financial & competing interests disclosure

The University California San Diego has received research funding for BM Ilfeld’s research from Smiths Medical (St Paul, MN, USA), Summit Medical (Sandy, UT, USA), Teleflex Medical (Research Triangle Park, NC, USA), Pacira Pharmaceuticals (Parsippany, NJ, USA), SPR Therapeutics (Chapel Hill, NC, USA) and Myoscience (Redwood City, CA, USA). BM Ilfeld has also received honoraria from Pacira Pharmaceuticals (Parsippany, NJ, USA). These companies had no input into any aspect of manuscript conceptualization or preparation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

The University California San Diego has received research funding for BM Ilfeld’s research from Smiths Medical (St Paul, MN, USA), Summit Medical (Sandy, UT, USA), Teleflex Medical (Research Triangle Park, NC, USA), Pacira Pharmaceuticals (Parsippany, NJ, USA), SPR Therapeutics (Chapel Hill, NC, USA) and Myoscience (Redwood City, CA, USA). BM Ilfeld has also received honoraria from Pacira Pharmaceuticals (Parsippany, NJ, USA). These companies had no input into any aspect of manuscript conceptualization or preparation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.