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Pain Management in Breast Surgery: Recommendations of a Multidisciplinary Expert Panel—The American Society of Breast Surgeons

Annals of Surgical Oncology volume 27, pages 4588–4602 (2020)Cite this article

Abstract

Opioid overdose accounted for more than 47,000 deaths in the United States in 2018. The risk of new persistent opioid use following breast cancer surgery is significant, with up to 10% of patients continuing to fill opioid prescriptions one year after surgery. Over prescription of opioids is far too common. A recent study suggested that up to 80% of patients receiving a prescription for opioids post-operatively do not need them (either do not fill the prescription or do not use the medication). In order to address this important issue, The American Society of Breast Surgeons empaneled an inter-disciplinary committee to develop a consensus statement on pain control for patients undergoing breast surgery. Representatives were nominated by the American College of Surgeons, the Society of Surgical Oncology, The American Society of Plastic Surgeons, and The American Society of Anesthesiologists. A broad literature review followed by a more focused review was performed by the inter-disciplinary panel which was comprised of 14 experts in the fields of breast surgery, anesthesiology, plastic surgery, rehabilitation medicine, and addiction medicine. Through a process of multiple revisions, a consensus was developed, resulting in the outline for decreased opioid use in patients undergoing breast surgery presented in this manuscript. The final document was reviewed and approved by the Board of Directors of the American Society of Breast Surgeons.

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References

  1. Centers for Disease Control and Prevention. Opioid overdose. https://www.cdc.gov/drugoverdose/index.html. Accessed 5 May 2020.

  2. U.S. Department of Health and Human Services. Wide-ranging online data for epidemiologic research (WONDER) M-C-o-Dhwcgn.

  3. Lee JS, Hu HM, Edelman AL, et al. New persistent opioid use among patients with cancer after curative-intent surgery. J Clin Oncol. 2017;35:4042–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Rao R, Jackson RS, Rosen B, et al. Pain control in breast surgery: survey of current practice and recommendations for optimizing management. American society of breast surgeons opioid/pain control workgroup. Ann Surg Oncol. 2020;27:985–90.

    PubMed  Google Scholar 

  5. Norris S, Shendale S. Decision-making for guideline development at WHO. In: Clark M editors. WHO handbook for guideline development. 2nd ed. Geneva: World Health Organization; 2014. p. 207–8.

    Google Scholar 

  6. Black N, Murphy M, Lamping D, et al. Consensus development methods: a review of best practice in creating clinical guidelines. J Health Serv Res Policy. 1999;4:236–48.

    CAS  PubMed  Google Scholar 

  7. Fecho K, Miller NR, Merritt SA, Klauber-Demore N, Hultman CS, Blau WS. Acute and persistent postoperative pain after breast surgery. Pain Med. 2009;10:708–15.

    PubMed  Google Scholar 

  8. Kulkarni AR, Pusic AL, Hamill JB, et al. Factors associated with acute postoperative pain following breast reconstruction. JPRAS Open. 2017;11:1–13.

    PubMed  Google Scholar 

  9. Gartner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA. 2009;302:1985–92.

    PubMed  Google Scholar 

  10. Wang L, Guyatt GH, Kennedy SA, et al. Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies. CMAJ. 2016;188:E352–61.

    PubMed  PubMed Central  Google Scholar 

  11. Andersen KG, Duriaud HM, Jensen HE, Kroman N, Kehlet H. Predictive factors for the development of persistent pain after breast cancer surgery. Pain. 2015;156:2413–22.

    PubMed  Google Scholar 

  12. Okamoto A, Yamasaki M, Yokota I, et al. Classification of acute pain trajectory after breast cancer surgery identifies patients at risk for persistent pain: a prospective observational study. J Pain Res. 2018;11:2197–206.

    PubMed  PubMed Central  Google Scholar 

  13. Edwards RR, Mensing G, Cahalan C, et al. Alteration in pain modulation in women with persistent pain after lumpectomy: influence of catastrophizing. J Pain Symptom Manag. 2013;46:30–42.

    PubMed  Google Scholar 

  14. Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118:934–44.

    PubMed  Google Scholar 

  15. Chow WL, Tan SM, Aung KCY, Chua SYN, Sim HC. Factors influencing quality of life of Asian breast cancer patients and their caregivers at diagnosis: perceived medical and psychosocial needs. Singap Med J. 2019;1:21.

    Google Scholar 

  16. Steffen LE, Johnson A, Levine BJ, Mayer DK, Avis NE. Met and unmet expectations for breast reconstruction in early posttreatment breast cancer survivors. Plast Surg Nurs. 2017;37:146–53.

    PubMed  PubMed Central  Google Scholar 

  17. Kiecolt-Glaser JK, Page GG, Marucha PT, MacCallum RC, Glaser R. Psychological influences on surgical recovery: perspectives from psychoneuroimmunology. Am Psychol. 1998;53:1209–18.

    CAS  PubMed  Google Scholar 

  18. Leysen L, Beckwee D, Nijs J, et al. Risk factors of pain in breast cancer survivors: a systematic review and meta-analysis. Support Care Cancer. 2017;25:3607–43.

    PubMed  Google Scholar 

  19. Schreiber KL, Zinboonyahgoon N, Xu X, et al. Preoperative psychosocial and psychophysical phenotypes as predictors of acute pain outcomes after breast surgery. J Pain. 2019;20:540–56.

    PubMed  Google Scholar 

  20. Ho AL, Klassen AF, Cano S, Scott AM, Pusic AL. Optimizing patient-centered care in breast reconstruction: the importance of preoperative information and patient-physician communication. Plast Reconstr Surg. 2013;132:212e–20e.

    CAS  PubMed  Google Scholar 

  21. Sheehan J, Sherman KA, Lam T, Boyages J. Association of information satisfaction, psychological distress, and monitoring coping style with post-decision regret following breast reconstruction. Psychooncology. 2007;16:342–51.

    PubMed  Google Scholar 

  22. Tarkowski R, Szmigiel K, Rubin A, et al. Patient’s education before mastectomy influences the rate of reconstructive surgery. J Cancer Educ. 2017;32:537–42.

    CAS  PubMed  Google Scholar 

  23. Zhong T, Hu J, Bagher S, et al. Decision regret following breast reconstruction: the role of self-efficacy and satisfaction with information in the preoperative period. Plast Reconstr Surg. 2013;132:724e–34e.

    CAS  PubMed  Google Scholar 

  24. De Groef A, Devoogdt N, Van der Gucht E, et al. EduCan trial: study protocol for a randomised controlled trial on the effectiveness of pain neuroscience education after breast cancer surgery on pain, physical, emotional, and work-related functioning. BMJ Open. 2019;9:e025742.

    PubMed  PubMed Central  Google Scholar 

  25. Halaszynski TM, Juda R, Silverman DG. Optimizing postoperative outcomes with efficient preoperative assessment and management. Crit Care Med. 2004;32:S76–86.

    PubMed  Google Scholar 

  26. Cavallaro PM, Milch H, Savitt L, et al. Addition of a scripted preoperative patient education module to an existing ERAS pathway further reduces length of stay. Am J Surg. 2018;216:652–7.

    PubMed  Google Scholar 

  27. de Aguilar-Nascimento JE, Leal FS, Dantas DC, et al. Preoperative education in cholecystectomy in the context of a multimodal protocol of perioperative care: a randomized, controlled trial. World J Surg. 2014;38:357–62.

    PubMed  Google Scholar 

  28. Carroll IR, Angst MS, Clark JD. Management of perioperative pain in patients chronically consuming opioids. Reg Anesth Pain Med. 2004;29:576–91.

    PubMed  Google Scholar 

  29. Nguyen LC, Sing DC, Bozic KJ. Preoperative reduction of opioid use before total joint arthroplasty. J Arthroplasty. 2016;31:282–7.

    PubMed  Google Scholar 

  30. Barker JC, DiBartola K, Wee C, et al. Preoperative multimodal analgesia decreases postanesthesia care unit narcotic use and pain scores in outpatient breast surgery. Plast Reconstr Surg. 2018;142:443e–50e.

    CAS  PubMed  Google Scholar 

  31. Chiu C, Aleshi P, Esserman LJ, et al. Improved analgesia and reduced postoperative nausea and vomiting after implementation of an enhanced recovery after surgery (ERAS) pathway for total mastectomy. BMC Anesthesiol. 2018;18:41.

    PubMed  PubMed Central  Google Scholar 

  32. Fan KL, Luvisa K, Black CK, et al. Gabapentin decreases narcotic usage: enhanced recovery after surgery pathway in free autologous breast reconstruction. Plast Reconstr Surg Glob Open. 2019;7:e2350.

    PubMed  PubMed Central  Google Scholar 

  33. Kaoutzanis C, Ganesh Kumar N, O’Neill D, et al. Enhanced recovery pathway in microvascular autologous tissue-based breast reconstruction: should it become the standard of care? Plast Reconstr Surg. 2018;141:841–51.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Kennedy GT, Hill CM, Huang Y, et al. Enhanced recovery after surgery (ERAS) protocol reduces perioperative narcotic requirement and length of stay in patients undergoing mastectomy with implant-based reconstruction. Am J Surg. 2019;220:147–52.

    PubMed  Google Scholar 

  35. Lombardi TM, Kahn BS, Tsai LJ, Waalen JM, Wachi N. Preemptive oral compared with intravenous acetaminophen for postoperative pain after robotic-assisted laparoscopic hysterectomy: a randomized controlled trial. Obstet Gynecol. 2019;134:1293–7.

    PubMed  Google Scholar 

  36. Plunkett A, Haley C, McCoart A, et al. A preliminary examination of the comparative efficacy of intravenous vs oral acetaminophen in the treatment of perioperative pain. Pain Med. 2017;18:2466–73.

    PubMed  Google Scholar 

  37. van der Westhuizen J, Kuo PY, Reed PW, Holder K. Randomised controlled trial comparing oral and intravenous paracetamol (acetaminophen) plasma levels when given as preoperative analgesia. Anaesth Intensive Care. 2011;39:242–6.

    PubMed  Google Scholar 

  38. Moller PL, Sindet-Pedersen S, Petersen CT, Juhl GI, Dillenschneider A, Skoglund LA. Onset of acetaminophen analgesia: comparison of oral and intravenous routes after third molar surgery. Br J Anaesth. 2005;94:642–8.

    CAS  PubMed  Google Scholar 

  39. Bourgeois FT, Graham DA, Kesselheim AS, Randolph AG. Cost implications of escalating intravenous acetaminophen use in children. JAMA Pediatr. 2019;173:489–91.

    PubMed  PubMed Central  Google Scholar 

  40. Amr YM, Yousef AA. Evaluation of efficacy of the perioperative administration of venlafaxine or gabapentin on acute and chronic postmastectomy pain. Clin J Pain. 2010;26:381–5.

    PubMed  Google Scholar 

  41. Bharti N, Bala I, Narayan V, Singh G. Effect of gabapentin pretreatment on propofol consumption, hemodynamic variables, and postoperative pain relief in breast cancer surgery. Acta Anaesthesiol Taiwan. 2013;51:10–13.

    PubMed  Google Scholar 

  42. Cheng GS, Ilfeld BM. An evidence-based review of the efficacy of perioperative analgesic techniques for breast cancer-related surgery. Pain Med. 2017;18:1344–65.

    PubMed  Google Scholar 

  43. Dirks J, Fredensborg BB, Christensen D, Fomsgaard JS, Flyger H, Dahl JB. A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy. Anesthesiology. 2002;97:560–4.

    CAS  PubMed  Google Scholar 

  44. Grover VK, Mathew PJ, Yaddanapudi S, Sehgal S. A single dose of preoperative gabapentin for pain reduction and requirement of morphine after total mastectomy and axillary dissection: randomized placebo-controlled double-blind trial. J Postgrad Med. 2009;55:257–60.

    CAS  PubMed  Google Scholar 

  45. Hah J, Mackey SC, Schmidt P, et al. Effect of perioperative gabapentin on postoperative pain resolution and opioid cessation in a mixed surgical cohort: a randomized clinical trial. JAMA Surg. 2018;153:303–11.

    PubMed  Google Scholar 

  46. Jiang Y, Li J, Lin H, et al. The efficacy of gabapentin in reducing pain intensity and morphine consumption after breast cancer surgery: a meta-analysis. Med Baltim. 2018;97:e11581.

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Rai AS, Khan JS, Dhaliwal J, et al. Preoperative pregabalin or gabapentin for acute and chronic postoperative pain among patients undergoing breast cancer surgery: a systematic review and meta-analysis of randomized controlled trials. J Plast Reconstr Aesthet Surg. 2017;70:1317–28.

    PubMed  Google Scholar 

  48. Kim SY, Song JW, Park B, Park S, An YJ, Shim YH. Pregabalin reduces postoperative pain after mastectomy: a double-blind, randomized, placebo-controlled study. Acta Anaesthesiol Scand. 2011;55:290–6.

    CAS  PubMed  Google Scholar 

  49. Mahran E, Hassan ME. Comparison of pregabalin versus ketamine in postoperative pain management in breast cancer surgery. Saudi J Anaesth. 2015;9:253–7.

    PubMed  PubMed Central  Google Scholar 

  50. Vig S, Kumar V, Deo S, Bhan S, Mishra S, Bhatnagar S. Effect of perioperative pregabalin on incidence of chronic postmastectomy pain syndrome: a prospective randomized placebo-controlled pilot study. Indian J Palliat Care. 2019;25:508–13.

    PubMed  PubMed Central  Google Scholar 

  51. Temple-Oberle C, Shea-Budgell MA, Tan M, et al. Consensus review of optimal perioperative care in breast reconstruction: Enhanced Recovery After Surgery (ERAS) Society recommendations. Plast Reconstr Surg. 2017;139:1056e–71e.

    CAS  PubMed  Google Scholar 

  52. Cavalcante AN, Sprung J, Schroeder DR, Weingarten TN. Multimodal analgesic therapy with gabapentin and its association with postoperative respiratory depression. Anesth Analg. 2017;125:141–6.

    CAS  PubMed  Google Scholar 

  53. Parsa AA, Sprouse-Blum AS, Jackowe DJ, Lee M, Oyama J, Parsa FD. Combined preoperative use of celecoxib and gabapentin in the management of postoperative pain. Aesthetic Plast Surg. 2009;33:98–103.

    PubMed  Google Scholar 

  54. Sun T, Sacan O, White PF, Coleman J, Rohrich RJ, Kenkel JM. Perioperative versus postoperative celecoxib on patient outcomes after major plastic surgery procedures (table of contents). Anesth Analg. 2008;106:950–8.

    CAS  PubMed  Google Scholar 

  55. Mitchell A, McCrea P, Inglis K, Porter G. A randomized, controlled trial comparing acetaminophen plus ibuprofen versus acetaminophen plus codeine plus caffeine (Tylenol 3) after outpatient breast surgery. Ann Surg Oncol. 2012;19:3792–800.

    PubMed  Google Scholar 

  56. Walker NJ, Jones VM, Kratky L, Chen H, Runyan CM. Hematoma risks of nonsteroidal anti-inflammatory drugs used in plastic surgery procedures: a systematic review and meta-analysis. Ann Plast Surg. 2019;82:S437–45.

    CAS  PubMed  Google Scholar 

  57. Bonde C, Khorasani H, Hoejvig J, Kehlet H. Cyclooxygenase-2 inhibitors and free flap complications after autologous breast reconstruction: a retrospective cohort study. J Plast Reconstr Aesthet Surg. 2017;70:1543–6.

    PubMed  Google Scholar 

  58. Kampe S, Warm M, Kaufmann J, Hundegger S, Mellinghoff H, Kiencke P. Clinical efficacy of controlled-release oxycodone 20 mg administered on a 12-h dosing schedule on the management of postoperative pain after breast surgery for cancer. Curr Med Res Opin. 2004;20:199–202.

    CAS  PubMed  Google Scholar 

  59. Thienthong S, Krisanaprakornkit W, Taesiri W, Thaninsurat N, Utsahapanich S, Klaichanad C. Two doses of oral sustained-release tramadol do not reduce pain or morphine consumption after modified radical mastectomy: a randomized, double blind, placebo-controlled trial. J Med Assoc Thail. 2004;87:24–32.

    PubMed  Google Scholar 

  60. Kim MH, Kim MS, Lee JH, Seo JH, Lee JR. Can quality of recovery be enhanced by premedication with midazolam? A prospective, randomized, double-blind study in females undergoing breast surgery. Med Baltim. 2017;96:e6107.

    CAS  PubMed  PubMed Central  Google Scholar 

  61. Bourazani M, Papageorgiou E, Zarkadas G, et al. The role of muscle relaxants: spasmolytic (thiocochlicoside) in postoperative pain management after mastectomy and breast reconstruction. Asian Pac J Cancer Prev. 2019;20:743–9.

    PubMed  PubMed Central  Google Scholar 

  62. Amraoui J, Pouliquen C, Fraisse J, et al. Effects of a hypnosis session before general anesthesia on postoperative outcomes in patients who underwent minor breast cancer surgery: the HYPNOSEIN randomized clinical trial. JAMA Netw Open. 2018;1:e181164.

    PubMed  PubMed Central  Google Scholar 

  63. Enqvist B, Bjorklund C, Engman M, Jakobsson J. Preoperative hypnosis reduces postoperative vomiting after surgery of the breasts. A prospective, randomized and blinded study. Acta Anaesthesiol Scand. 1997;41:1028–32.

    CAS  PubMed  Google Scholar 

  64. Franco L, Blanck TJ, Dugan K, et al. Both lavender fleur oil and unscented oil aromatherapy reduce preoperative anxiety in breast surgery patients: a randomized trial. J Clin Anesth. 2016;33:243–9.

    PubMed  Google Scholar 

  65. Lew MW, Kravits K, Garberoglio C, Williams AC. Use of preoperative hypnosis to reduce postoperative pain and anesthesia-related side effects. Int J Clin Exp Hypn. 2011;59:406–23.

    PubMed  Google Scholar 

  66. Potie A, Roelants F, Pospiech A, Momeni M, Watremez C. Hypnosis in the perioperative management of breast cancer surgery: clinical benefits and potential implications. Anesthesiol Res Pract. 2016;2016:2942416.

    PubMed  PubMed Central  Google Scholar 

  67. Lee A, Gin T, Lau AS, Ng FF. A comparison of patients’ and health care professionals’ preferences for symptoms during immediate postoperative recovery and the management of postoperative nausea and vomiting. Anesth Analg. 2005;100:87–93.

    PubMed  Google Scholar 

  68. Apfelbaum JL, Silverstein JH, Chung FF, et al. Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists task force on postanesthetic care. Anesthesiology. 2013;118:291–307.

    PubMed  Google Scholar 

  69. Manahan MA, Basdag B, Kalmar CL, et al. Risk of severe and refractory postoperative nausea and vomiting in patients undergoing DIEP flap breast reconstruction. Microsurgery. 2014;34:112–21.

    PubMed  Google Scholar 

  70. Carlisle JB, Stevenson CA. Drugs for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2006;3:CD004125.

    Google Scholar 

  71. Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014;118:85–113.

    PubMed  Google Scholar 

  72. Parikh RP, Myckatyn TM. Paravertebral blocks and enhanced recovery after surgery protocols in breast reconstructive surgery: patient selection and perspectives. J Pain Res. 2018;11:1567–81.

    PubMed  PubMed Central  Google Scholar 

  73. Shaikh SI, Nagarekha D, Hegade G, Marutheesh M. Postoperative nausea and vomiting: a simple yet complex problem. Anesth Essays Res. 2016;10:388–96.

    PubMed  PubMed Central  Google Scholar 

  74. De Oliveira GS Jr, Castro-Alves LJ, Ahmad S, Kendall MC, McCarthy RJ. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesth Analg. 2013;116:58–74.

    PubMed  Google Scholar 

  75. Apfel CC, Zhang K, George E, et al. Transdermal scopolamine for the prevention of postoperative nausea and vomiting: a systematic review and meta-analysis. Clin Ther. 2010;32:1987–2002.

    CAS  PubMed  Google Scholar 

  76. Ilfeld BM, Madison SJ, Suresh PJ, et al. Persistent postmastectomy pain and pain-related physical and emotional functioning with and without a continuous paravertebral nerve block: a prospective 1-year follow-up assessment of a randomized, triple-masked, placebo-controlled study. Ann Surg Oncol. 2015;22:2017–25.

    PubMed  Google Scholar 

  77. Ilfeld BM, Madison SJ, Suresh PJ, et al. Treatment of postmastectomy pain with ambulatory continuous paravertebral nerve blocks: a randomized, triple-masked, placebo-controlled study. Reg Anesth Pain Med. 2014;39:89–96.

    CAS  PubMed  PubMed Central  Google Scholar 

  78. Belzarena SD. Comparative study between thoracic epidural block and general anesthesia for oncologic mastectomy. Rev Bras Anestesiol. 2008;58:561–8.

    PubMed  Google Scholar 

  79. Yeh CC, Yu JC, Wu CT, Ho ST, Chang TM, Wong CS. Thoracic epidural anesthesia for pain relief and postoperation recovery with modified radical mastectomy. World J Surg. 1999;23:256–60; discussion 260–251.

    CAS  PubMed  Google Scholar 

  80. Abdallah FW, Morgan PJ, Cil T, et al. Ultrasound-guided multilevel paravertebral blocks and total intravenous anesthesia improve the quality of recovery after ambulatory breast tumor resection. Anesthesiology. 2014;120:703–13.

    CAS  PubMed  Google Scholar 

  81. Arunakul P, Ruksa A. General anesthesia with thoracic paravertebral block for modified radical mastectomy. J Med Assoc Thai. 2010;93(Suppl 7):S149–53.

    PubMed  Google Scholar 

  82. Bansal P, Saxena KN, Taneja B, Sareen B. A comparative randomized study of paravertebral block versus wound infiltration of bupivacaine in modified radical mastectomy. J Anaesthesiol Clin Pharmacol. 2012;28:76–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  83. Gacio MF, Lousame AM, Pereira S, Castro C, Santos J. Paravertebral block for management of acute postoperative pain and intercostobrachial neuralgia in major breast surgery. Braz J Anesthesiol. 2016;66:475–84.

    PubMed  Google Scholar 

  84. Gupta K, Srikanth K, Girdhar KK, Chan V. Analgesic efficacy of ultrasound-guided paravertebral block versus serratus plane block for modified radical mastectomy: a randomised, controlled trial. Indian J Anaesth. 2017;61:381–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  85. Kairaluoma PM, Bachmann MS, Korpinen AK, Rosenberg PH, Pere PJ. Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy (table of contents). Anesth Analg. 2004;99:1837–43.

    PubMed  Google Scholar 

  86. Kundra P, Varadharajan R, Yuvaraj K, Vinayagam S. Comparison of paravertebral and interpleural block in patients undergoing modified radical mastectomy. J Anaesthesiol Clin Pharmacol. 2013;29:459–64.

    PubMed  PubMed Central  Google Scholar 

  87. Naja MZ, Ziade MF, Lonnqvist PA. Nerve-stimulator guided paravertebral blockade vs general anaesthesia for breast surgery: a prospective randomized trial. Eur J Anaesthesiol. 2003;20:897–903.

    CAS  PubMed  Google Scholar 

  88. Pei L, Zhou Y, Tan G, et al. Ultrasound-assisted thoracic paravertebral block reduces intraoperative opioid requirement and improves analgesia after breast cancer surgery: a randomized, controlled, single-center trial. PloS One. 2015;10:e0142249.

    PubMed  PubMed Central  Google Scholar 

  89. Pusch F, Freitag H, Weinstabl C, Obwegeser R, Huber E, Wildling E. Single-injection paravertebral block compared to general anaesthesia in breast surgery. Acta Anaesthesiol Scand. 1999;43:770–4.

    CAS  PubMed  Google Scholar 

  90. Sidiropoulou T, Buonomo O, Fabbi E, et al. A prospective comparison of continuous wound infiltration with ropivacaine versus single-injection paravertebral block after modified radical mastectomy (table of contents). Anesth Analg. 2008;106:997–1001.

    CAS  PubMed  Google Scholar 

  91. Terkawi AS, Tsang S, Sessler DI, et al. Improving analgesic efficacy and safety of thoracic paravertebral block for breast surgery: a mixed-effects meta-analysis. Pain Physician. 2015;18:E757–80.

    PubMed  Google Scholar 

  92. Jacobs A, Lemoine A, Joshi GP, Van de Velde M, Bonnet F, Collaborators PWG. PROSPECT guideline for oncological breast surgery: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2020;75:664–73.

    CAS  PubMed  PubMed Central  Google Scholar 

  93. Aksu C, Kus A, Yorukoglu HU, Tor Kilic C, Gurkan Y. Analgesic effect of the bi-level injection erector spinae plane block after breast surgery: a randomized controlled trial. Agri. 2019;31:132–7.

    PubMed  Google Scholar 

  94. Al Ja’bari A, Robertson M, El-Boghdadly K, Albrecht E. A randomised controlled trial of the pectoral nerves-2 (PECS-2) block for radical mastectomy. Anaesthesia. 2019;74:1277–81.

    PubMed  Google Scholar 

  95. Bashandy GM, Abbas DN. Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: a randomized clinical trial. Reg Anesth Pain Med. 2015;40:68–74.

    CAS  PubMed  Google Scholar 

  96. Choi JJ, Jo YY, Kim SH, et al. Remifentanil-sparing effect of pectoral nerve block type II in breast surgery under surgical pleth index-guided analgesia during total intravenous anesthesia. J Clin Med. 2019;8:1181.

    PubMed Central  Google Scholar 

  97. Cros J, Senges P, Kaprelian S, et al. Pectoral I block does not improve postoperative analgesia after breast cancer surgery: a randomized, double-blind, dual-centered controlled trial. Reg Anesth Pain Med. 2018;43:596–604.

    PubMed  Google Scholar 

  98. De Cassai A, Bonanno C, Sandei L, Finozzi F, Carron M, Marchet A. PECS II block is associated with lower incidence of chronic pain after breast surgery. Korean J Pain. 2019;32:286–91.

    PubMed  PubMed Central  Google Scholar 

  99. Gurkan Y, Aksu C, Kus A, Yorukoglu UH. Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: a randomized controlled trial. J Clin Anesth. 2020;59:84–8.

    PubMed  Google Scholar 

  100. Hong B, Bang S, Chung W, Yoo S, Chung J, Kim S. Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study. Korean J Pain. 2019;32:206–14.

    PubMed  PubMed Central  Google Scholar 

  101. Lovett-Carter D, Kendall MC, McCormick ZL, Suh EI, Cohen AD, De Oliveira GS. Pectoral nerve blocks and postoperative pain outcomes after mastectomy: a meta-analysis of randomized controlled trials. Reg Anesth Pain Med. 2019. https://doi.org/10.1136/rapm-2019-100658.

    Article  PubMed  Google Scholar 

  102. Neethu M, Pandey RK, Sharma A, et al. Pectoral nerve blocks to improve analgesia after breast cancer surgery: a prospective, randomized, and controlled trial. J Clin Anesth. 2018;45:12–7.

    CAS  Google Scholar 

  103. Matsumoto M, Flores EM, Kimachi PP, et al. Benefits in radical mastectomy protocol: a randomized trial evaluating the use of regional anesthesia. Sci Rep. 2018;8:7815.

    PubMed  PubMed Central  Google Scholar 

  104. Najeeb HN, Mehdi SR, Siddiqui AM, Batool SK. Pectoral nerves I, II and serratus plane blocks in multimodal analgesia for mastectomy: a randomised clinical trial. J Coll Physicians Surg Pak. 2019;29:910–4.

    PubMed  Google Scholar 

  105. Senapathi TGA, Widnyana IMG, Aribawa I, Jaya A, Junaedi IMD. Combined ultrasound-guided Pecs II block and general anesthesia are effective for reducing pain from modified radical mastectomy. J Pain Res. 2019;12:1353–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  106. Wang K, Zhang X, Zhang T, et al. The efficacy of ultrasound-guided type II pectoral nerve blocks in perioperative pain management for immediate reconstruction after modified radical mastectomy: a prospective, randomized study. Clin J Pain. 2018;34:231–6.

    PubMed  Google Scholar 

  107. Wang W, Song W, Yang C, et al. Ultrasound-guided pectoral nerve block I and serratus-intercostal plane block alleviate postoperative pain in patients undergoing modified radical mastectomy. Pain Physician. 2019;22:E315–23.

    PubMed  Google Scholar 

  108. Zhao J, Han F, Yang Y, Li H, Li Z. Pectoral nerve block in anesthesia for modified radical mastectomy: a meta-analysis based on randomized controlled trials. Med Baltim. 2019;98:e15423.

    PubMed  PubMed Central  Google Scholar 

  109. Kulhari S, Bharti N, Bala I, Arora S, Singh G. Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial. Br J Anaesth. 2016;117:382–6.

    CAS  PubMed  Google Scholar 

  110. Siddeshwara A, Singariya G, Kamal M, Kumari K, Seervi S, Kumar R. Comparison of efficacy of ultrasound-guided pectoral nerve block versus thoracic paravertebral block using levobupivacaine and dexamethasone for postoperative analgesia after modified radical mastectomy: a randomized controlled trial. Saudi J Anaesth. 2019;13:325–31.

    PubMed  PubMed Central  Google Scholar 

  111. Syal K, Chandel A. Comparison of the postoperative analgesic effect of paravertebral block, pectoral nerve block, and local infiltration in patients undergoing modified radical mastectomy: a randomised double-blind trial. Indian J Anaesth. 2017;61:643–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  112. Tripathy S, Mandal I, Rao PB, Panda A, Mishra T, Kar M. Opioid-free anesthesia for breast cancer surgery: a comparison of ultrasound-guided paravertebral and pectoral nerve blocks. A randomized controlled trial. J Anaesthesiol Clin Pharmacol. 2019;35:475–80.

    PubMed  PubMed Central  Google Scholar 

  113. Fujii T, Shibata Y, Akane A, et al. A randomised controlled trial of pectoral nerve-2 (PECS 2) block vs serratus plane block for chronic pain after mastectomy. Anaesthesia. 2019;74:1558–62.

    CAS  PubMed  Google Scholar 

  114. Altiparmak B, Korkmaz Toker M, Uysal AI, Turan M, Gumus Demirbilek S. Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of patients after radical mastectomy surgery: a prospective, randomized, controlled trial. J Clin Anesth. 2019;54:61–5.

    PubMed  Google Scholar 

  115. Sinha C, Kumar A, Kumar A, Prasad C, Singh PK, Priya D. Pectoral nerve versus erector spinae block for breast surgeries: a randomised controlled trial. Indian J Anaesth. 2019;63:617–22.

    CAS  PubMed  PubMed Central  Google Scholar 

  116. Swisher MW, Wallace AM, Sztain JF, et al. Erector spinae plane versus paravertebral nerve blocks for postoperative analgesia after breast surgery: a randomized clinical trial. Reg Anesth Pain Med. 2020;45:260–6.

    PubMed  Google Scholar 

  117. Albi-Feldzer A, Mouret-Fourme EE, Hamouda S, et al. A double-blind randomized trial of wound and intercostal space infiltration with ropivacaine during breast cancer surgery: effects on chronic postoperative pain. Anesthesiology. 2013;118:318–26.

    CAS  PubMed  Google Scholar 

  118. Lanier ST, Lewis KC, Kendall MC, et al. Intraoperative nerve blocks fail to improve quality of recovery after tissue expander breast reconstruction: a prospective, double-blinded, randomized, placebo-controlled clinical trial. Plast Reconstr Surg. 2018;141:590–7.

    CAS  PubMed  Google Scholar 

  119. Lee PY, Tsai PS, Huang YH, Huang CJ. Inhibition of toll-like receptor-4, nuclear factor-kappaB and mitogen-activated protein kinase by lignocaine may involve voltage-sensitive sodium channels. Clin Exp Pharmacol Physiol. 2008;35:1052–8.

    CAS  PubMed  Google Scholar 

  120. Byager N, Hansen MS, Mathiesen O, Dahl JB. The analgesic effect of wound infiltration with local anaesthetics after breast surgery: a qualitative systematic review. Acta Anaesthesiol Scand. 2014;58:402–10.

    CAS  PubMed  Google Scholar 

  121. Tam KW, Chen SY, Huang TW, et al. Effect of wound infiltration with ropivacaine or bupivacaine analgesia in breast cancer surgery: a meta-analysis of randomized controlled trials. Int J Surg. 2015;22:79–85.

    PubMed  Google Scholar 

  122. Rojas KE, Fortes TA, Flom PL, Manasseh DM, Andaz C, Borgen PI. Mastectomy is no longer an indication for postoperative opioid prescription at discharge. Am J Surg. 2019;218:700–5.

    PubMed  Google Scholar 

  123. Butz DR, Shenaq DS, Rundell VL, et al. Postoperative pain and length of stay lowered by use of exparel in immediate, implant-based breast reconstruction. Plast Reconstr Surg Glob Open. 2015;3:e391.

    PubMed  PubMed Central  Google Scholar 

  124. Abdelsattar JM, Boughey JC, Fahy AS, et al. Comparative study of liposomal bupivacaine versus paravertebral block for pain control following mastectomy with immediate tissue expander reconstruction. Ann Surg Oncol. 2016;23:465–70.

    PubMed  Google Scholar 

  125. Ilfeld BM, Gabriel RA, Eisenach JC. Liposomal bupivacaine infiltration for knee arthroplasty: significant analgesic benefits or just a bunch of fat? Anesthesiology. 2018;129:623–6.

    CAS  PubMed  Google Scholar 

  126. Ohnesorge H, Bein B, Hanss R, et al. Paracetamol versus metamizol in the treatment of postoperative pain after breast surgery: a randomized, controlled trial. Eur J Anaesthesiol. 2009;26:648–53.

    CAS  PubMed  Google Scholar 

  127. McNicol ED, Ferguson MC, Haroutounian S, Carr DB, Schumann R. Single-dose intravenous paracetamol or intravenous propacetamol for postoperative pain. Cochrane Database Syst Rev. 2016;5:CD007126.

    Google Scholar 

  128. Hickman SR, Mathieson KM, Bradford LM, Garman CD, Gregg RW, Lukens DW. Randomized trial of oral versus intravenous acetaminophen for postoperative pain control. Am J Health Syst Pharm. 2018;75:367–75.

    PubMed  Google Scholar 

  129. Rojas KE, Fortes TA, Flom P, Manasseh DM, Andaz C, Borgen P. Intraoperative ketorolac use does not increase the risk of bleeding in breast surgery. Ann Surg Oncol. 2019;26:3368–73.

    PubMed  Google Scholar 

  130. Nguyen BN, Barta RJ, Stewart CE, Wheelwright M, Heinrich CA. Ketorolac for patients undergoing implant-based breast reconstruction: impact on hospital length of stay and postoperative narcotic use. Aesthet Surg J. 2020;40:174–9.

    PubMed  Google Scholar 

  131. Gobble RM, Hoang HL, Kachniarz B, Orgill DP. Ketorolac does not increase perioperative bleeding: a meta-analysis of randomized controlled trials. Plast Reconstr Surg. 2014;133:741–55.

    CAS  PubMed  Google Scholar 

  132. Sharma S, Chang DW, Koutz C, et al. Incidence of hematoma associated with ketorolac after TRAM flap breast reconstruction. Plast Reconstr Surg. 2001;107:352–5.

    CAS  PubMed  Google Scholar 

  133. Feldman HI, Kinman JL, Berlin JA, et al. Parenteral ketorolac: the risk for acute renal failure. Ann Intern Med. 1997;126:193–9.

    CAS  PubMed  Google Scholar 

  134. Motov S, Yasavolian M, Likourezos A, et al. Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. Ann Emerg Med. 2017;70:177–84.

    PubMed  Google Scholar 

  135. Hartford LB, Van Koughnett JAM, Murphy PB, et al. The standardization of outpatient procedure (STOP) narcotics: a prospective health systems intervention to reduce opioid use in ambulatory breast surgery. Ann Surg Oncol. 2019;26:3295–304.

    PubMed  Google Scholar 

  136. Sada A, Thiels CA, Britain MK, et al. Optimizing discharge opioid-prescribing practices after mastectomy with immediate reconstruction. Mayo Clin Proc Innov Qual Outcomes. 2019;3:183–8.

    PubMed  PubMed Central  Google Scholar 

  137. Hill MV, Stucke RS, McMahon ML, Beeman JL, Barth RJ Jr. An educational intervention decreases opioid prescribing after general surgical operations. Ann Surg. 2018;267:468–72.

    PubMed  Google Scholar 

  138. Park KU, Kyrish K, Terrell J, et al. Surgeon perception versus reality: opioid use after breast cancer surgery. J Surg Oncol. 2019;119:909–15.

    PubMed  Google Scholar 

  139. Thiels CA, Ubl DS, Yost KJ, et al. Results of a prospective, multicenter initiative aimed at developing opioid-prescribing guidelines after surgery. Ann Surg. 2018;268:457–68.

    PubMed  Google Scholar 

  140. Huynh VRK, Christian N, Ahrendt G, Jaiswal K, Murphy C, Cumbler E, Tevis S. An evaluation of opiate-prescribing patterns of residents and attendings in breast surgery. American Society of Breast Surgeons Annual Meeting, 20202020.

  141. Chiu AS, Healy JM, DeWane MP, Longo WE, Yoo PS. Trainees as agents of change in the opioid epidemic: optimizing the opioid prescription practices of surgical residents. J Surg Educ. 2018;75:65–71.

    PubMed  Google Scholar 

  142. Woeste MR, Bhutiani N, Geller AE, Eldridge-Hindy H, McMasters KM, Ajkay N. Identifying factors predicting prolonged opioid use after mastectomy. Ann Surg Oncol. 2020;27:993–1001.

    PubMed  Google Scholar 

  143. Lee JS, Howard RA, Klueh MP, et al. The impact of education and prescribing guidelines on opioid-prescribing for breast and melanoma procedures. Ann Surg Oncol. 2019;26:17–24.

    PubMed  Google Scholar 

  144. Park KU, Kyrish K, Yi M, et al. Opioid use after breast-conserving surgery: prospective evaluation of risk factors for high opioid use. Ann Surg Oncol. 2020;27:730–5.

    PubMed  Google Scholar 

  145. Riff C, Guilhaumou R, Marsot A, et al. Ropivacaine wound infiltration for pain management after breast cancer mastectomy: a population pharmacokinetic analysis. Clin Pharmacol Drug Dev. 2018;7:811–9.

    CAS  PubMed  Google Scholar 

  146. Bouman EA, Theunissen M, Kessels AG, et al. Continuous paravertebral block for postoperative pain compared to general anaesthesia and wound infiltration for major oncological breast surgery. Springerplus. 2014;3:517.

    PubMed  PubMed Central  Google Scholar 

  147. Raghavendra GK, Sreenivasa RH, Ashok K, et al. Surgically placed wound catheters (SPWC) and local anaesthetic infusion in breast surgery: efficacy and safety analysis. Breast Dis. 2011;33:1–8.

    CAS  PubMed  Google Scholar 

  148. Morrison JE Jr, Jacobs VR. Reduction or elimination of postoperative pain medication after mastectomy through use of a temporarily placed local anesthetic pump vs control group. Zentralbl Gynakol. 2003;125:17–22.

    PubMed  Google Scholar 

  149. Ferreira Laso L, Lopez-Picado A, Lamata L, et al. Postoperative analgesia by infusion of local anesthetic into the surgical wound after modified radical mastectomy: a randomized clinical trial. Plast Reconstr Surg. 2014;134:862e–70e.

    CAS  PubMed  Google Scholar 

  150. Pacik PT, Nelson CE, Werner C. Pain control in augmentation mammaplasty using indwelling catheters in 687 consecutive patients: data analysis. Aesthet Surg J. 2008;28:631–41.

    PubMed  Google Scholar 

  151. Strazisar B, Besic N, Ahcan U. Does a continuous local anaesthetic pain treatment after immediate tissue expander reconstruction in breast carcinoma patients more efficiently reduce acute postoperative pain: a prospective randomised study. World J Surg Oncol. 2014;12:16.

    PubMed  PubMed Central  Google Scholar 

  152. Giordano S, Verajankorva E, Koskivuo I, Suominen E. Effectiveness of local anaesthetic pain catheters for abdominal donor site analgesia in patients undergoing free lower abdominal flap breast reconstruction: a meta-analysis of comparative studies. J Plast Surg Hand Surg. 2013;47:428–33.

    PubMed  Google Scholar 

  153. Heller L, Kowalski AM, Wei C, Butler CE. Prospective, randomized, double-blind trial of local anesthetic infusion and intravenous narcotic patient-controlled anesthesia pump for pain management after free TRAM flap breast reconstruction. Plast Reconstr Surg. 2008;122:1010–8.

    CAS  PubMed  Google Scholar 

  154. Dagtekin O, Hotz A, Kampe S, Auweiler M, Warm M. Postoperative analgesia and flap perfusion after pedicled TRAM flap reconstruction: continuous wound instillation with ropivacaine 0.2%: a pilot study. J Plast Reconstr Aesthet Surg. 2009;62:618–25.

    PubMed  Google Scholar 

  155. Silver JK, Baima J, Mayer RS. Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship. CA Cancer J Clin. 2013;63:295–317.

    PubMed  Google Scholar 

  156. Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J. 2011;5:342–8.

    PubMed  PubMed Central  Google Scholar 

  157. Baima J, Reynolds SG, Edmiston K, Larkin A, Ward BM, O’Connor A. Teaching of independent exercises for prehabilitation in breast cancer. J Cancer Educ. 2017;32:252–6.

    PubMed  Google Scholar 

  158. Nilsson H, Angeras U, Bock D, et al. Is preoperative physical activity related to post-surgery recovery? A cohort study of patients with breast cancer. BMJ Open. 2016;6:e007997.

    PubMed  PubMed Central  Google Scholar 

  159. Santa Mina D, Brahmbhatt P, Lopez C, et al. The case for prehabilitation prior to breast cancer treatment. PM R. 2017;9:S305–16.

    PubMed  Google Scholar 

  160. Batdorf NJ, Lemaine V, Lovely JK, et al. Enhanced recovery after surgery in microvascular breast reconstruction. J Plast Reconstr Aesthet Surg. 2015;68:395–402.

    PubMed  Google Scholar 

  161. McNeely ML, Campbell K, Ospina M, et al. Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database Syst Rev. 2010;6:CD005211.

    Google Scholar 

  162. Bradt J, Shim M, Goodill SW. Dance/movement therapy for improving psychological and physical outcomes in cancer patients. Cochrane Database Syst Rev. 2015;1:CD007103.

    PubMed  Google Scholar 

  163. Stout NL, Baima J, Swisher AK, Winters-Stone KM, Welsh J. A systematic review of exercise systematic reviews in the cancer literature (2005–2017). PM R. 2017;9:S347–84.

    PubMed  PubMed Central  Google Scholar 

  164. Zhu G, Zhang X, Wang Y, Xiong H, Zhao Y, Sun F. Effects of exercise intervention in breast cancer survivors: a meta-analysis of 33 randomized controlled trails. Onco Targets Ther. 2016;9:2153–68.

    CAS  PubMed  PubMed Central  Google Scholar 

  165. Ligibel JA, Dillon D, Giobbie-Hurder A, et al. Impact of a preoperative exercise intervention on breast cancer proliferation and gene expression: results from the preoperative health and body (PreHAB) study. Clin Cancer Res. 2019;25:5398–406.

    CAS  PubMed  Google Scholar 

  166. Palmer JB, Lane D, Mayo D, Schluchter M, Leeming R. Effects of music therapy on anesthesia requirements and anxiety in women undergoing ambulatory breast surgery for cancer diagnosis and treatment: a randomized controlled trial. J Clin Oncol. 2015;33:3162–8.

    PubMed  Google Scholar 

  167. Soo MS, Jarosz JA, Wren AA, et al. Imaging-guided core-needle breast biopsy: impact of meditation and music interventions on patient anxiety, pain, and fatigue. J Am Coll Radiol. 2016;13:526–34.

    PubMed  Google Scholar 

  168. Bringman H, Giesecke K, Thorne A, Bringman S. Relaxing music as pre-medication before surgery: a randomised controlled trial. Acta Anaesthesiol Scand. 2009;53:759–64.

    CAS  PubMed  Google Scholar 

  169. Kang HJ, Nam ES, Lee Y, Kim M. How strong is the evidence for the anxiolytic efficacy of lavender? Systematic review and meta-analysis of randomized controlled trials. Asian Nurs Res Korean Soc Nurs Sci. 2019;13:295–305.

    PubMed  Google Scholar 

  170. Watkins AA, Johnson TV, Shrewsberry AB, et al. Ice packs reduce postoperative midline incision pain and narcotic use: a randomized controlled trial. J Am Coll Surg. 2014;219:511–7.

    PubMed  Google Scholar 

  171. Drackley NL, Degnim AC, Jakub JW, et al. Effect of massage therapy for postsurgical mastectomy recipients. Clin J Oncol Nurs. 2012;16:121–4.

    PubMed  Google Scholar 

  172. Mitchinson AR, Kim HM, Rosenberg JM, et al. Acute postoperative pain management using massage as an adjuvant therapy: a randomized trial. Arch Surg. 2007;142:1158–67; discussion 1167.

    PubMed  Google Scholar 

  173. Bauer BA, Cutshall SM, Wentworth LJ, et al. Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study. Complement Ther Clin Pract. 2010;16:70–5.

    PubMed  Google Scholar 

  174. Nelson EA, Dowsey MM, Knowles SR, et al. Systematic review of the efficacy of pre-surgical mind–body based therapies on postoperative outcome measures. Complement Ther Med. 2013;21:697–711.

    PubMed  Google Scholar 

  175. Nguyen J, Brymer E. Nature-based guided imagery as an intervention for state anxiety. Front Psychol. 2018;9:1858.

    PubMed  PubMed Central  Google Scholar 

  176. Tusek DL, Cwynar R, Cosgrove DM. Effect of guided imagery on length of stay, pain, and anxiety in cardiac surgery patients. J Cardiovasc Manag. 1999;10:22–8.

    CAS  PubMed  Google Scholar 

  177. Silva JG, Santana CG, Inocencio KR, Orsini M, Machado S, Bergmann A. Electrocortical analysis of patients with intercostobrachial pain treated with TENS after breast cancer surgery. J Phys Ther Sci. 2014;26:349–53.

    PubMed  PubMed Central  Google Scholar 

  178. Robb KA, Newham DJ, Williams JE. Transcutaneous electrical nerve stimulation vs transcutaneous spinal electroanalgesia for chronic pain associated with breast cancer treatments. J Pain Symptom Manag. 2007;33:410–9.

    PubMed  Google Scholar 

  179. Berliere M, Roelants F, Watremez C, et al. The advantages of hypnosis intervention on breast cancer surgery and adjuvant therapy. Breast. 2018;37:114–8.

    CAS  PubMed  Google Scholar 

  180. Hansen MV, Andersen LT, Madsen MT, et al. Effect of melatonin on depressive symptoms and anxiety in patients undergoing breast cancer surgery: a randomized, double-blind, placebo-controlled trial. Breast Cancer Res Treat. 2014;145:683–95.

    CAS  PubMed  Google Scholar 

  181. Thrane S, Cohen SM. Effect of Reiki therapy on pain and anxiety in adults: an in-depth literature review of randomized trials with effect size calculations. Pain Manag Nurs. 2014;15:897–908.

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Virginia, Charlottesville, VA, USA

    David R. Brenin MD & Anneke T. Schroen MD

  2. Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Jill R. Dietz MD

  3. Department of Physical Medicine and Rehabilitation, UMass Memorial Medical Center, Worcester, MA, USA

    Jennifer Baima MD

  4. Department of Anesthesia, University of Texas Southwestern, Dallas, TX, USA

    Gloria Cheng MD

  5. Department of Surgery, Mayo Clinic, Owatonna, MN, USA

    Joshua Froman MD

  6. Department of Surgery, Moffitt Cancer Center, Tampa, FL, USA

    Christine Laronga MD

  7. Surgery and Integrative Medicine, Scripps Health, La Jolla, CA, USA

    Ayemoethu Ma MD

  8. Department of Plastic Surgery, Johns Hopkins University, Baltimore, MD, USA

    Michele A. Manahan MD

  9. Department of Anesthesia, Stanford University, Stanford, CA, USA

    Edward R. Mariano MD

  10. Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA

    Kristin Rojas MD

  11. Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA

    Nassima Ait-Daoud Tiouririne MD

  12. New York Presbyterian Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA

    Lisa S. Wiechmann MD & Roshni Rao MD

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  1. David R. Brenin MD
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Correspondence to David R. Brenin MD.

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Royalties for Christine Laronga are less than $5000 per year. Kristin Rojas receives speaker’s honoraria from Pacira Pharmaceuticals. The remaining authors have no conflicts of interest.

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David R Brenin, Jill R Dietz, Jennifer Baima, Ayemoethu Ma, Nassima Ait-Daoud Tiouririne, Lisa S Wiechmann, and Roshni Rao are American Society of Breast Surgeons nominees. Joshua Froman and Anneke T Schroen are American College of Surgeons nominees. Christine Laronga and Kristin Rojas are Society of Surgical Oncology nominees. Michele A Manahan is American Society of Plastic Surgeons nominee. Gloria Cheng and Edward R Mariano are American Society of Anesthesiologists nominees.

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Brenin, D.R., Dietz, J.R., Baima, J. et al. Pain Management in Breast Surgery: Recommendations of a Multidisciplinary Expert Panel—The American Society of Breast Surgeons. Ann Surg Oncol 27, 4588–4602 (2020). https://doi.org/10.1245/s10434-020-08892-x

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