{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T04:07:29Z","timestamp":1792382849979,"version":"4.4.0"},"reference-count":115,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Regional anesthesia techniques are increasingly used to improve analgesia and reduce opioid consumption after breast surgery. Several approaches have been proposed, including paravertebral block and different fascial plane blocks, but their comparative effectiveness remains uncertain. This network meta-analysis (NMA) aimed to compare the efficacy and safety of regional anesthesia techniques in patients undergoing mastectomy with or without axillary clearance. A systematic review and NMA of randomized controlled trials were conducted according to established methodological guidelines. Studies evaluating regional anesthesia techniques in patients undergoing mastectomy were included. Outcomes assessed were intraoperative opioid consumption, 24-hour postoperative morphine milligram equivalents (MMEs), pain at rest and with movement at 12 and 24 hours, postoperative nausea and vomiting (PONV), use of rescue analgesics, and the incidence of complications such as pneumothorax and local anesthetic systemic toxicity (LAST). Regional anesthesia techniques were associated with improved analgesic outcomes compared with LA infiltration or no regional block. Paravertebral block showed the most consistent benefit across outcomes, particularly for opioid consumption and postoperative pain. Fascial plane blocks demonstrated comparable performance to paravertebral blocks for most outcomes, although paravertebral blocks showed superior results for pain on movement. LA infiltration alone or the absence of regional anesthesia performed worse across most outcomes. Serious complications were rarely reported. Paravertebral block appears to provide the most consistent analgesic benefit for mastectomy when performed by experienced practitioners. Fascial plane blocks represent a reasonable alternative when a paravertebral block is not feasible. Simple surgical infiltration alone appears insufficient for optimal analgesia in major breast surgery.<\/jats:p>","DOI":"10.4103\/sja.sja_226_26","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:00:28Z","timestamp":1782968428000},"page":"615-624","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Regional anesthesia in breast surgery: An Italian expert consensus \u2013 Part 2: Results from a network meta-analysis evaluating 103 randomized controlled trials on regional anesthesia techniques for mastectomy with or without axillary clearance"],"prefix":"10.4103","volume":"20","author":[{"given":"Domenico P.","family":"Santonastaso","sequence":"first","affiliation":[{"name":"Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"De Cassai","sequence":"additional","affiliation":[{"name":"Institute of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eros","family":"Pilia","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Coppolino","sequence":"additional","affiliation":[{"name":"Department of Women, Child and General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Melegari","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intesive Care, Azienda Ospedaliero Universitaria Policlinico di Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Piccioni","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care IRCCS Humanitas Research Hospital Rozzano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Boscolo","sequence":"additional","affiliation":[{"name":"Institute of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Pettenuzzo","sequence":"additional","affiliation":[{"name":"Institute of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Fattorini","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, San Sebastiano Hospital, Frascati (Rome), Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Togn\u00f9","sequence":"additional","affiliation":[{"name":"Anesthesia, Intensive Care and Pain Medicine Unit. ASST Gaetano Pini-CTO, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Sepolvere","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Cardiac Surgery Intensive Care Unit, Casa Di cura San Michele, Maddaloni, Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Scimia","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Unit, Giuseppe Mazzini Hospital, Teramo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Curcio","sequence":"additional","affiliation":[{"name":"Breast Surgery Unit Morgagni-Pierantoni Hospital, Forl\u00ec, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claude T.","family":"Bagaphou","sequence":"additional","affiliation":[{"name":"Section of Anesthesia, Intensive Care and Pain Medicine, Ospedale di Castello. Citt\u00e0 di Castello, Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Coviello","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples \u201cFederico II\u201d, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Morelli","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Boschetto","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Marandola","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Pietrantozzi","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Clemente","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care - Santo Spirito Hospital, ASL Roma 1, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Gentili","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Unit, Principe di Piemonte Hospital, Senigallia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Rispoli","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care AO dei Colli - Monaldi Hospital, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Lubrano","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Buonconsiglio Fatebenefratelli Hospital in Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario M.","family":"Mattiacci","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care AO dei Colli - Monaldi Hospital, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moana R.","family":"Nespoli","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care AO dei Colli - Monaldi Hospital, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiano","family":"D\u2019Errico","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care New Coastal Hospital \u2013 Sorrento, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Costa","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Unit - Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Pascarella","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Unit - Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Bizzarri","sequence":"additional","affiliation":[{"name":"Anesthesia and intensive care unit, AUSL-IRCCS-Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Ranieri","sequence":"additional","affiliation":[{"name":"UOC Anesthesia and Operating Theaters Isola Tiberina Hospital \u2013 Gemelli Isola Department of Emergency and Internal Medicine, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Rocco","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Tonetti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy"},{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Secondo","family":"Folli","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery. Fondazione IRCCS Istituto Nazionale dei Tumori Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annabella","family":"de Chiara","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Tedesco","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Unit and Pain Therapy, Mater Dei Hospital, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Pusceddu","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, G. 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