• Li Wang, Jared C Cohen, Niveditha Devasenapathy, Brian Y Hong, Sasha Kheyson, Daniel Lu, Yvgeniy Oparin, Sean A Kennedy, Beatriz Romerosa, Nikita Arora, Henry Y Kwon, Kate Jackson, Manya Prasad, Dulitha Jayasekera, Allen Li, Giuliana Guarna, Shane Natalwalla, Rachel J Couban, Susan Reid, James S Khan, Michael McGillion, and Jason W Busse.
• Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada; Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China. Electronic address: wangli1@mcmaster.ca.
• Br J Anaesth. 2020 Sep 1; 125 (3): 346-357.

BackgroundThe prevalence and intensity of persistent post-surgical pain (PPSP) after breast cancer surgery are uncertain. We conducted a systematic review and meta-analysis to further elucidate this issue.MethodsWe searched MEDLINE, Embase, CINAHL, and PsycINFO, from inception to November 2018, for observational studies reporting persistent pain (≥3 months) after breast cancer surgery. We used random-effects meta-analysis and the Grading of Recommendations, Assessment, Development and Evaluations approach to rate quality of evidence.ResultsWe included 187 observational studies with 297 612 breast cancer patients. The prevalence of PPSP ranged from 2% to 78%, median 37% (inter-quartile range: 22-48%); the pooled prevalence was 35% (95% confidence interval [CI]: 32-39%). The pooled pain intensity was 3.9 cm on a 10 cm visual analogue scale (95% CI: 3.6-4.2 cm). Moderate-quality evidence supported the subgroup effects of PPSP prevalence for localized pain vs any pain (29% vs 44%), moderate or greater vs any pain (26% vs 44%), clinician-assessed vs patient-reported pain (23% vs 36%), and whether patients underwent sentinel lymph node biopsy vs axillary lymph node dissection (26% vs 43%). The adjusted analysis found that the prevalence of patient-reported PPSP (any severity/location) was 46% (95% CI: 36-56%), and the prevalence of patient-reported moderate-to-severe PPSP at any location was 27% (95% CI: 10-43%).ConclusionsModerate-quality evidence suggests that almost half of all women undergoing breast cancer surgery develop persistent post-surgical pain, and about one in four develop moderate-to-severe persistent post-surgical pain; the higher prevalence was associated with axillary lymph node dissection. Future studies should explore whether nerve sparing for axillary procedures reduces persistent post-surgical pain after breast cancer surgery.Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

20 keywords...

hide…