Perioperative Breast Analgesia: a Systematic Review of the Evidence for Perioperative Analgesic Medications

• Published in: Current pain and headache reports 2022-04, Vol.26 (4), p.299-321
• Main Authors: Maniker, Robert B., Damiano, James, Ivie, Ryan M. J., Pavelic, Martin, Woodworth, Glenn E.
• Format: Article
• Language: English
• Subjects: Acute Pain Medicine (R Urman; Adult; Analgesia - methods; Analgesics; Analgesics - therapeutic use; Analgesics, Opioid - therapeutic use; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Anticonvulsants; Anticonvulsants - therapeutic use; Breast Neoplasms - drug therapy; Breast surgery; Female; Humans; Internal Medicine; Medicine; Medicine & Public Health; N-Methylaspartate - therapeutic use; Narcotics; Pain Medicine; Pain, Postoperative - drug therapy; Section Editor; Surgery; Topical Collection on Acute Pain Medicine
• ISSN: 1531-3433; 1534-3081
• DOI: 10.1007/s11916-022-01031-z

Purpose of Review Breast surgery is common and may result in significant acute as well as chronic pain. A wide range of pharmacologic interventions is available including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), N -methyl- d -aspartate (NMDA) receptor antagonists, anticonvulsants, and other non-opioids with analgesic properties. We present a review of the evidence for these pharmacologic interventions. A literature search of the MEDLINE database was performed via PubMed with combined terms related to breast surgery, anesthesia, and analgesia. Articles were limited to randomized controlled trial (RCT) design, adult patients undergoing elective surgery on the breast (not including biopsy), and pharmacologic interventions only. Article titles and abstracts were screened, and risk of bias assessments were performed. Recent Findings The search strategy initially captured 7254 articles of which 60 articles met the full inclusion criteria. Articles were organized according to intervention: 6 opioid agonists, 14 NSAIDs and acetaminophen, 4 alpha-2 agonists, 7 NMDA receptor antagonists, 6 local anesthetics, 7 steroids, 15 anticonvulsants (one of which also discussed an NMDA antagonist), 1 antiarrhythmic, and 2 serotonin reuptake inhibitors (one of which also studied an anticonvulsant). Summary A wide variety of medications is effective for perioperative breast analgesia, but results vary by agent and dose. The most efficacious are likely NSAIDs and anticonvulsants. Some agents may also decrease the incidence of chronic postoperative pain, including flurbiprofen, gabapentin, venlafaxine, and memantine. While many individual agents are well studied, optimal combinations of analgesic medications remain unclear.