Dahl Victoria, Remer Hallie B, Narvaez-Rojas Alexis, Morgan Orly, Möller Mecker G, Danker Sara
Miller School of Medicine, Education, University of Miami, Miami, United States.
Department of Surgery, Division of Surgical Oncology, University of Miami Health System, Miami, United States.
Rep Pract Oncol Radiother. 2025 Jun 7;30(2):223-235. doi: 10.5603/rpor.105039. eCollection 2025.
Reduction of postoperative analgesic consumption in breast cancer patients is of significant clinical interest. Some studies have demonstrated promising results related to the efficacy of liposomal bupivacaine (LB), a long-acting local analgesic used intraoperatively, in reducing opioid consumption after aesthetic breast surgery. The purpose of this review is to evaluate postoperative opioid consumption when using LB in aesthetic breast surgery oncologic breast surgery to help clinicians better understand trends in pain outcomes in breast cancer patients. A literature search was conducted to identify records reporting postoperative opioid consumption for patients undergoing oncologic mastectomy with and without breast reconstruction (BR) and aesthetic breast surgery. Of the 779 records reviewed, 15 met inclusion criteria representing 2,453 patients. Of these, none of the oncologic procedures without BR showed reduced opioid consumption with LB. A meta-analysis of oncologic procedures with BR and aesthetic breast procedures showed significant effect size (ES) estimates of reduced postoperative opioid consumption when using LB compared to control anesthetics [ES: 1.698 ± 0.8624; 95% confidence interval (CI): 0.005, -3.390; p = 0.049 and ES: 1.212 ± 0.3053; 95% CI: 1.810-0.613; p < 0.001, respectively). In conclusion, intraoperative LB reduces postoperative opioid consumption for oncologic breast surgery with BR and aesthetic breast procedures. LB is understudied in mastectomy without BR and more research is needed. Neoadjuvant treatment and procedural differences could contribute to different pain outcomes. Further investigation could help uncover the etiology of post mastectomy pain syndromes.
减少乳腺癌患者术后镇痛药物的使用量具有重要的临床意义。一些研究表明，脂质体布比卡因（LB）作为一种术中使用的长效局部镇痛药，在减少美容性乳房手术后的阿片类药物使用量方面取得了令人鼓舞的效果。本综述的目的是评估在美容性乳房手术和肿瘤性乳房手术中使用LB时的术后阿片类药物使用量，以帮助临床医生更好地了解乳腺癌患者疼痛结局的趋势。进行了文献检索，以确定报告接受有或无乳房重建（BR）的肿瘤性乳房切除术以及美容性乳房手术患者术后阿片类药物使用量的记录。在审查的779条记录中，有15条符合纳入标准，代表2453例患者。其中，没有BR的肿瘤手术均未显示LB能减少阿片类药物的使用量。对有BR的肿瘤手术和美容性乳房手术进行的荟萃分析显示，与对照麻醉剂相比，使用LB时术后阿片类药物使用量减少的效应量（ES）估计值具有统计学意义[ES：1.698±0.8624；95%置信区间（CI）：0.005，-3.390；p = 0.049和ES：1.212±0.3053；95%CI：1.810 - 0.613；p < 0.001]。总之，术中使用LB可减少有BR的肿瘤性乳房手术和美容性乳房手术的术后阿片类药物使用量。在没有BR的乳房切除术中，LB的研究较少，需要更多的研究。新辅助治疗和手术差异可能导致不同的疼痛结局。进一步的研究可能有助于揭示乳房切除术后疼痛综合征的病因。
