{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T03:02:43Z","timestamp":1788490963244,"version":"build-2803163510"},"reference-count":78,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,1,26]],"date-time":"2020-01-26T00:00:00Z","timestamp":1579996800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Analgesic protocols used to treat pain after breast surgery vary significantly. The aim of this systematic review was to evaluate the available literature on this topic and develop recommendations for optimal pain management after oncological breast surgery. A systematic review using preferred reporting items for systematic reviews and meta\u2010analysis guidance with procedure\u2010specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Seven hundred and forty\u2010nine studies were found, of which 53 randomised controlled trials and nine meta\u2010analyses met the inclusion criteria and were included in this review. Quantitative analysis suggests that dexamethasone and gabapentin reduced postoperative pain. The use of paravertebral blocks also reduced postoperative pain scores, analgesia consumption and the incidence of postoperative nausea and vomiting. Intra\u2010operative opioid requirements were documented to be lower when a pectoral nerves block was performed, which also reduced postoperative pain scores and opioid consumption. We recommend basic analgesics (i.e. paracetamol and non\u2010steroidal anti\u2010inflammatory drugs) administered pre\u2010operatively or intra\u2010operatively and continued postoperatively. In addition, pre\u2010operative gabapentin and dexamethasone are also recommended. In major breast surgery, a regional anaesthetic technique such as paravertebral block or pectoral nerves block and\/or local anaesthetic wound infiltration may be considered for additional pain relief. Paravertebral block may be continued postoperatively using catheter techniques. Opioids should be reserved as rescue analgesics in the postoperative period. Research is needed to evaluate the role of novel regional analgesic techniques such as erector spinae plane or retrolaminar plane blocks combined with basic analgesics in an enhanced recovery setting.<\/jats:p>","DOI":"10.1111\/anae.14964","type":"journal-article","created":{"date-parts":[[2020,1,26]],"date-time":"2020-01-26T23:49:31Z","timestamp":1580082571000},"page":"664-673","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":205,"title":["PROSPECT guideline for oncological breast surgery: a\u00a0systematic review and procedure\u2010specific postoperative pain management recommendations"],"prefix":"10.1111","volume":"75","author":[{"given":"A.","family":"Jacobs","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences KULeuven and University Hospital Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Lemoine","sequence":"additional","affiliation":[{"name":"Service d'Anesth\u00e9sie \u2013 R\u00e9animation et M\u00e9decine P\u00e9ri\u2010op\u00e9ratoire Hopital Tenon APHP Paris, France\/M\u00e9decine\u2010Sorbonne Universit\u00e9 Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. P.","family":"Joshi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Management University of Texas Southwestern Medical Center Dallas TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Van de Velde","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences KULeuven and University Hospital Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Bonnet","sequence":"additional","affiliation":[{"name":"Service d'Anesth\u00e9sie \u2013 R\u00e9animation et M\u00e9decine P\u00e9ri\u2010op\u00e9ratoire Hopital Tenon APHP Paris, France\/M\u00e9decine\u2010Sorbonne Universit\u00e9 Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the PROSPECT Working Group collaborators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,1,26]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1177\/000313480807400402","article-title":"Pain after mastectomy and breast reconstruction","volume":"74","author":"Vadivelu N","year":"2008","journal-title":"American Surgeon"},{"key":"e_1_2_11_3_1","unstructured":"BonnetF CamuF BarrangerE.Non cosmetic breast surgery analgesia \u2010 Prospect review2006;https:\/\/esraeurope.org\/wp-content\/uploads\/2019\/03\/Summary-recommendations_Breast-surgery_EN.pdf(accessed 27\/11\/2019)."},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1097\/AAP.0000000000000750","article-title":"Interfascial plane blocks: back to basics","volume":"43","author":"Elsharkawy H","year":"2018","journal-title":"Regional Anesthesia and Pain Medicine"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.bpa.2014.03.005","article-title":"Procedure\u2010specific pain management and outcome strategies","volume":"28","author":"Joshi GP","year":"2014","journal-title":"Best Practice and Research Clinical Anaesthesiology"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.bpa.2018.06.012","article-title":"Procedure\u2010specific pain management (PROSPECT) \u2013 an update","volume":"32","author":"Lee B","year":"2018","journal-title":"Best Practice and Research. 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