Tageza Ilala Tajera, Teku Ayano Gudeta, Ahmed Kedir Yesuf, Tamiru Mamo Selam
Department of Anesthesia, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia.
Anesthesiol Res Pract. 2023 Nov 3;2023:5668399. doi: 10.1155/2023/5668399. eCollection 2023.
Breast surgery for breast cancer is associated with significant acute and persistent postoperative pain. Surgery is the primary type of treatment, but up to 60% of breast cancer patients experience persistent pain after surgery, and 40% of them develop acute postmastectomy pain syndrome. Preoperative stress, involvement of lymph nodes while dissecting, and the postoperative psychological state of the patients play vital roles in managing the postoperative pain of the patients. The objective of this study is to develop evidence-based guideline on the prevention and management of perioperative pain for breast cancer surgical patients.
An exhaustive literature search was made from PubMed, Cochrane Review, PubMed, Google Scholar, Hinari, and CINAHIL databases that are published from 2012 to 2022 by setting the inclusion and exclusion criteria. After data extraction, filtering was made based on the methodological quality, population data, interventions, and outcome of interest. Finally, one guideline, two meta-analyses, ten systematic reviews, 25 randomized clinical trials and ten observational studies are included in this review, and a conclusion was made based on their level of evidence and grade of recommendation.
A total of 38 studies were considered in this evaluation. The development of this guideline was based on different studies performed on the diagnosis, risk stratification and risk reduction, prevention of postoperative pain, and treatments of postoperative pain.
The management of postoperative pain can be categorized as risk assessment, minimizing risk, early diagnosis, and treatment. Early diagnosis is the mainstay to identify and initiate treatment. The perioperative use of a nonpharmacological approach (including preoperative positive inspirational words and positive expectation) as an adjunct to the intraoperative regional anesthetic technique with general anesthesia with proper dosage of the standard pharmacological multimodal regimens is the first-line treatment. For postoperative analgesia, an extended form of intraoperative regional technique, nonpharmacologic technique, and NSAIDs can be used with the opioid-sparing anesthesia technique.
乳腺癌乳房手术会导致严重的急性和持续性术后疼痛。手术是主要的治疗方式，但高达60%的乳腺癌患者术后会经历持续性疼痛，其中40%会发展为急性乳房切除术后疼痛综合征。术前应激、解剖时淋巴结受累情况以及患者的术后心理状态在患者术后疼痛管理中起着至关重要的作用。本研究的目的是制定基于证据的乳腺癌手术患者围手术期疼痛预防和管理指南。
通过设定纳入和排除标准，对2012年至2022年发表在PubMed、Cochrane综述、PubMed、谷歌学术、Hinari和CINAHIL数据库上的文献进行了详尽的检索。在数据提取后，根据方法学质量、人群数据、干预措施和感兴趣的结果进行筛选。最后，本综述纳入了一项指南、两项荟萃分析、十项系统评价、二十五项随机临床试验和十项观察性研究，并根据它们的证据水平和推荐等级得出结论。
本评价共纳入38项研究。本指南的制定基于对诊断、风险分层与降低、术后疼痛预防及治疗等方面进行的不同研究。
术后疼痛管理可分为风险评估、风险最小化、早期诊断和治疗。早期诊断是识别和启动治疗的关键。围手术期使用非药物方法（包括术前积极的鼓励性话语和积极的期望）作为术中区域麻醉技术与全身麻醉的辅助手段，并适当使用标准药理学多模式方案，是一线治疗方法。对于术后镇痛，可采用术中区域技术的扩展形式、非药物技术和非甾体抗炎药，并结合阿片类药物节省麻醉技术。
