Acute and chronic pain following breast surgery

Background

Successful acute pain management after breast surgery remains challenging, and if not achieved, may increase the likelihood of subsequent chronic pain.

Aims

This article aimed to evaluate the evidence for varied techniques described for peri-operative pain management in breast surgery, and to review the literature on chronic pain after breast surgery and particularly ‘post-mastectomy pain syndrome’.

Method

A Pubmed search was performed, with the key words “mastectomy” and “pain” for articles in the English language in the adult human population (age > 19 years), looking specifically for different analgesic techniques that have been evaluated.

Results

Thirty-three peer-reviewed publications with pain outcome data were included, ranging from 15 to 289 patients per study (total n = 2104). Twenty three were randomised controlled trials and the rest were prospective or retrospective audits and case series. Inconsistent trial methodology precluded a meta-analysis. Paravertebral local anaesthetic nerve blockade resulted in lower pain scores and fewer side effects than opioid-based regimens. Three risk factors emerged predicting chronic pain post-mastectomy: higher post-operative pain scores, age <65 years and inclusion of major reconstructive surgery.

Conclusion

Paravertebral block should be considered for use in major breast surgery. Pain control should be optimised/a priority for both acute care and to potentially reduce chronic pain.