Pascal RD Clephas, Sharon Orbach-Zinger, Martina A Gosteli-Peter, Moshe Hoshen, Stephen Halpern, Nicole D Hilber, Cornelia Leo, Michael Heesen
Are there differences in benefits and harms among regional pain management techniques in women undergoing breast cancer surgery?
Key messages
- Overall, we found that different pain blocks were similar for managing pain after breast cancer surgery.
- Complication rates were low among all pain block techniques.
What is regional analgesia, and how does it work?
Regional analgesia is a pain block technique used in breast cancer surgery. It involves injecting pain‐numbing medicine near specific nerves in the breast area to block pain signals during and after surgery. Unlike opioids, which affect the whole body, regional analgesia targets only the nerves. Different regional analgesia techniques target different nerves, as shown below.
- Paravertebral block: near the spine
- Erector spinae plane block: along the back muscles
- Pectoral nerve block: in the chest area
- Serratus anterior plane block: near the sides of the chest
Why is this important for women undergoing breast cancer surgery?
Pain after breast surgery can cause problems, lead to longer hospital stays, and even result in long‐term pain. Opioids, commonly used for pain relief, have side effects such as nausea and vomiting. Regional analgesia is important because it effectively reduces pain while avoiding the risks associated with opioids.
What did we want to find out?
This review looked at how well regional analgesia techniques work and how safe they are. We compared different types of nerve blocks to see their effects on pain levels and possible complications.
What did we do?
We searched for high‐quality medical studies that compared different types of nerve blocks for breast cancer surgery. We analysed their combined effects on pain and complications using advanced statistical methods. We evaluated erector spinae plane block, pectoral nerve block, and serratus anterior plane block against paravertebral block.
What did we find?
We included 39 studies involving 2348 women. The studies were conducted between 2013 and 2023. The results of the most important outcomes are summarised below.
- For reducing pain at rest two hours after surgery, pectoral nerve block is slightly more effective than paravertebral block, but this difference is not clinically meaningful. Compared with paravertebral block, erector spinae plane block is similarly effective, and serratus anterior plane block probably has similar effectiveness.
- For reducing pain during movement two hours after surgery, pectoral nerve block may be more effective than paravertebral block. Erector spinae plane block and paravertebral block may be similarly effective.
- For reducing pain at rest 24 hours after surgery, pectoral nerve block is slightly more effective than paravertebral block, but this difference is not clinically meaningful. Compared with paravertebral block, erector spinae plane block and serratus anterior plane block are similarly effective.
- For reducing pain during movement 24 hours after surgery, compared with paravertebral block, erector spinae plane block probably has similar effectiveness, pectoral nerve block may be similarly effective, and serratus anterior plane block may be similarly effective, but the last result is very uncertain.
- For reducing pain at rest 48 hours after surgery, one study reported no difference between paravertebral block and erector spinae plane block, but the result is very uncertain.
- For reducing pain during movement 48 hours after surgery, pectoral nerve block and erector spinae plane block may be similarly effective compared with paravertebral block, but both results are very uncertain.
- In the three studies that recorded complications of regional analgesia, no complications occurred.
Overall, we found that the different regional analgesia techniques were similarly effective for managing pain management, and that all had low complication rates.
What are the limitations of the evidence?
Some factors reduced our confidence in the evidence. First, some comparisons included few studies and participants, making the results less reliable. Second, studies sometimes had different findings, making it harder to draw clear conclusions. Third, we excluded some studies from our analysis because we considered their methods were not sufficiently robust. Finally, where studies did not provide results, we had to calculate them ourselves, which may have added some uncertainty.
How up to date is this evidence?
The review is current to 6 June 2023.