{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:08:20Z","timestamp":1782864500228,"version":"3.54.5"},"reference-count":26,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study investigated the relationship between preoperative serum vitamin D levels and acute postoperative pain scores in patients undergoing unilateral breast cancer surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study was conducted at Fayoum University Hospital between September 2024 and April 2025. 184 American Society of Anesthesiologists (ASA) II\u2013III female patients scheduled to undergo elective unilateral modified radical mastectomy were classified into two groups: 92 vitamin D-deficient (&lt;30\u2009nmol\/L) and 92 vitamin D-sufficient (\u226530\u2009nmol\/L). The primary outcome was the occurrence of moderate to severe postoperative pain (Numerical Rating Scale (NRS) &gt;3) at 12 hours. A secondary 24-hour composite outcome (NRS &gt;3\u2009at any time within the first 24 hours) was used for the multivariable logistic regression. Other secondary outcomes included: preoperative serum 25(OH)D level, postoperative NRS, intraoperative fentanyl consumption, postoperative tramadol consumption, sedation scores, intraoperative and postoperative hemodynamics, patient satisfaction, and hospital stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The baseline characteristics were well balanced between the groups, with small standardized mean differences for all variables. Patients with vitamin D deficiency had a higher occurrence of moderate to severe pain at 12 hours. In multivariable analysis, vitamin D deficiency was independently associated with moderate to severe postoperative pain at any time point during the first 24 hours (adjusted OR 3.12, 95%\u2009CI 1.58 to 6.13). Vitamin D-deficient patients had higher intraoperative fentanyl consumption (mean difference 8.04\u2009\u00b5g, 95%\u2009CI 3.21 to 12.88)\u2009and postoperative tramadol consumption (mean difference 112.17\u2009mg, 95%\u2009CI 101.44 to 122.91).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Vitamin D deficiency is associated with a higher occurrence of moderate to severe postoperative pain and increased opioid consumption in patients undergoing unilateral modified radical mastectomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2025-107495","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T23:55:16Z","timestamp":1779234916000},"page":"rapm-2025-107495","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Association between preoperative vitamin D level and postoperative pain in patients undergoing breast cancer surgery: a prospective observational study"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9723-2224","authenticated-orcid":false,"given":"Mahdy Ahmed","family":"Abdelhady","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Fayoum University Faculty of Medicine, Fayoum, Fayoum Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5979-1239","authenticated-orcid":false,"given":"Maged Labib","family":"Boulos","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Fayoum University Faculty of Medicine, Fayoum, Fayoum Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2951-5940","authenticated-orcid":false,"given":"Mohamed Ahmed","family":"Hamed","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Fayoum University Faculty of Medicine, Fayoum, Fayoum Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7817-5025","authenticated-orcid":false,"given":"Doha Hamad","family":"Masry","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Fayoum University Faculty of Medicine, Fayoum, Fayoum Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safaa Gaber","family":"Ragab","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Fayoum University Faculty of Medicine, Fayoum, Fayoum Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2000-7424","authenticated-orcid":false,"given":"Mohamed Hasan","family":"Ragab","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Fayoum University Faculty of Medicine, Fayoum, Fayoum Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"2026051916551358000_rapm-2025-107495v1.1","doi-asserted-by":"crossref","first-page":"3189","DOI":"10.2147\/JPR.S382407","article-title":"Preoperative Vitamin D Level is Associated with Acute Pain After Video-Assisted Thoracoscopic Surgery: A Retrospective Cohort Study","volume":"15","author":"Zeng","year":"2022","journal-title":"J Pain Res"},{"key":"2026051916551358000_rapm-2025-107495v1.2","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13968"},{"key":"2026051916551358000_rapm-2025-107495v1.3","doi-asserted-by":"crossref","first-page":"409","DOI":"10.4103\/2230-8210.95684","article-title":"Vitamin D deficiency in newly diagnosed breast cancer patients","volume":"16","author":"Imtiaz","year":"2012","journal-title":"Indian J Endocrinol 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