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Chronic pain may develop after any routine surgery, but it can have a far greater incidence after amputation, thoracotomy or mastectomy. The peak noxious barrage due to the neural trauma associated with these operations may be reduced in the perioperative period with the potential to reduce the risk of chronic pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Databases and data treatment<\/jats:title><jats:p>A systematic review of the evidence for perioperative interventions reducing acute and chronic pain associated with amputation, mastectomy or thoracotomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010two randomized controlled trials met the inclusion criteria. Gabapentinoids reduced pain after mastectomy, but a single dose was ineffective for thoracotomy patients who had an epidural. Gabapentinoids were ineffective for vascular amputees with pre\u2010existing chronic pain. Venlafaxine was associated with less chronic pain after mastectomy. Intravenous and topical lidocaine and perioperative <jats:styled-content style=\"fixed-case\">EMLA<\/jats:styled-content> (eutectic mixture of local anaesthetic) cream reduced the incidence of chronic pain after mastectomy, whereas local anaesthetic infiltration appeared ineffective. The majority of the trials investigating regional analgesia found it to be beneficial for chronic symptoms. Ketamine and intercostal cryoanalgesia offered no reduction in chronic pain. Total intravenous anaesthesia (<jats:styled-content style=\"fixed-case\">TIVA<\/jats:styled-content>) reduced the incidence of post\u2010thoracotomy pain in one study, whereas high\u2010dose remifentanil exacerbated chronic pain in another.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Appropriate dose regimes of gabapentinoids, antidepressants, local anaesthetics and regional anaesthesia may potentially reduce the severity of both acute and chronic pain for patients. Ketamine was not effective at reducing chronic pain. Intercostal cryoanalgesia was not effective and has the potential to increase the risk of chronic pain. <jats:styled-content style=\"fixed-case\">TIVA<\/jats:styled-content> may be beneficial but the effects of opioids are unclear.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ejp.567","type":"journal-article","created":{"date-parts":[[2014,8,4]],"date-time":"2014-08-04T09:55:33Z","timestamp":1407146133000},"page":"451-465","source":"Crossref","is-referenced-by-count":193,"title":["A systematic review of therapeutic interventions to reduce acute and chronic post\u2010surgical pain after amputation, thoracotomy or mastectomy"],"prefix":"10.1002","volume":"19","author":[{"given":"S.R.","family":"Humble","sequence":"first","affiliation":[{"name":"Department of Anaesthetics and Pain Management Charing Cross Hospital  London UK"},{"name":"Peripheral Neuropathy Unit, Hammersmith Hospital Campus Imperial College London  Du Cane Road London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.J.","family":"Dalton","sequence":"additional","affiliation":[{"name":"Department of Anaesthetics and Pain Management Ninewells Hospital and Medical School  Dundee UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anaesthetics and Pain Management Ninewells Hospital and Medical School  Dundee UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,8,4]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31827d88d8"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e3181cb406e"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200603000-00025"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra025411"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annfar.2008.10.006"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(00)00482-6"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365520510023675"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/ael004"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2004.12.010"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0b013e318185cf73"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181c4273a"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(03)01023-3"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200209000-00007"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpain.2008.06.013"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2007.08.033"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200210000-00036"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00115550-200007000-00005"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ANE.0000180200.11626.8E"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0b013e32830c900c"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2011.01.055"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e31823b9cc8"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.4103\/0022-3859.58928"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2004.19.1.74"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2006.06.004"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/SPC.0b013e328300eb24"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X0403200305"},{"key":"e_1_2_9_28_1","unstructured":"Higgins J.P.T. 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