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The aim of this systematic review was to update existing recommendations for postoperative pain management after major oncological breast surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review was undertaken following PROcedure SPECific postoperative pain managemenT (PROSPECT) methodology. Randomised controlled trials and systematic reviews that investigated peri\u2010operative analgesic, anaesthetic and surgical interventions were included. The evidence for these interventions was reviewed using a modified Delphi process for their invasiveness, efficacy, adverse effects and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 176 randomised controlled trials and eight systematic reviews were included. Analgesia with paracetamol, nonsteroidal anti\u2010inflammatory drugs or cyclooxygenase\u20102 inhibitors, and dexamethasone continues to be advocated. Given the occurrence of problematic adverse effects, gabapentin is no longer recommended. Single\u2010shot erector spinae plane block; interpectoral plane and pectoserratus plane block; superficial serratus anterior plane block; deep serratus anterior plane block; thoracic paravertebral block; and local infiltration analgesia are recommended. We no longer recommend a continuous thoracic paravertebral block, as single\u2010shot regional analgesic modalities are sufficient to cover the worst part of the acute pain trajectory. Physiotherapy in the pre\u2010operative and postoperative period is recommended. No perineural adjuncts; specific surgical techniques; or complementary medicine therapies are recommended.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The updated PROSPECT recommendations for pain management following major oncological breast surgery include pre\u2010 or intra\u2010 and postoperative administration of paracetamol; nonsteroidal anti\u2010inflammatory drugs or cyclooxygenase\u20102 selective inhibitors; dexamethasone; single\u2010shot regional analgesic techniques; and physiotherapy. The value of regional analgesic techniques is underlined, but the listed single\u2010shot regional analgesic techniques are considered equivalent to each other.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anae.70313","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T07:07:07Z","timestamp":1786518427000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Pain management after major oncological breast surgery: an updated systematic review and procedure specific postoperative pain management (\n                    <scp>PROSPECT<\/scp>\n                    ) recommendations"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7298-9407","authenticated-orcid":false,"given":"Neel","family":"Desai","sequence":"first","affiliation":[{"name":"Department of Anaesthesia Guy's and St Thomas' NHS Foundation Trust  London UK"},{"name":"Faculty of Life Sciences 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Hospital Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girish 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"}]},{"name":"the PROSPECT Working Group of the\u00a0European Society of Regional Anaesthesia and Pain Therapy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"World Cancer Research Fund.Breast cancer statistics.2025.https:\/\/www.wcrf.org\/preventing\u2010cancer\/cancer\u2010statistics\/breast\u2010cancer\u2010statistics\/(accessed 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