Effect of wound infiltration with ropivacaine or bupivacaine analgesia in breast cancer surgery: A meta-analysis of randomized controlled trials.

Abstract

BACKGROUND:

Although not completely painless, breast-conserving surgery is considerably less painful than modified radical mastectomy. Local anesthetics are speculated to reduce postoperative pain when placed at the surgical site. Thus, we conducted a systematic review of randomized controlled trials to evaluate the efficacy of bupivacaine or ropivacaine analgesia for pain relief in breast cancer surgery.

METHODS:

PubMed, Embase, the Cochrane Library, Scopus, and the ClinicalTrials.gov registry were searched for studies published up to July 2015. Individual effect sizes were standardized, and a meta-analysis was performed to calculate a pooled effect size by using random effects models. Pain was assessed using a visual analog scale at 1, 2, 12, and 24 h postoperatively. The secondary outcomes included complications and analgesic consumption.

RESULTS:

We reviewed 13 trials with 1150 patients. We found no difference in postoperative pain reduction at 1, 12, and 24 h after breast cancer surgery between the experimental and control groups. The severity of pain was significantly reduced in the experimental group (weighted mean difference -0.19; 95% confidence interval: -0.39-0.00) at 2 h postoperatively. Moreover, postoperative analgesic consumption did not differ significantly between the groups. No major drug-related complication was observed in any study.

CONCLUSION:

Administration of the local anesthetics bupivacaine or ropivacaine during breast cancer surgery decreased pain significantly at only 2 h but did not reduce pain at 12, and 24 h postoperatively.

• Authors: Ka-Wai Tam, Shin-Yan Chen, Tsai-Wei Huang, Chao-Chun Lin, Chih-Ming Su, Ching-Li Li, Yuan-Soon Ho, Wan-Yu Wang, Chih-Hsiung Wu
• Journal: International journal of surgery (London, England) (Int J Surg) Vol. 22 Pg. 79-85 (Oct 2015) ISSN: 1743-9159 [Electronic] England
• PMID: 26277531 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Amides
• Anesthetics, Local
• Ropivacaine
• Bupivacaine

Topics

• Amides (administration & dosage)
• Anesthetics, Local (administration & dosage)
• Breast Neoplasms (surgery)
• Bupivacaine (administration & dosage)
• Female
• Humans
• Mastectomy, Segmental (adverse effects)
• Pain Management
• Pain Measurement
• Pain, Postoperative (prevention & control)
• Randomized Controlled Trials as Topic
• Ropivacaine