• Ka-Wai Tam, Shin-Yan Chen, Tsai-Wei Huang, Chao-Chun Lin, Chih-Ming Su, Ching-Li Li, Yuan-Soon Ho, Wan-Yu Wang, and Chih-Hsiung Wu.
• Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan; Center for Evidence-based Health Care, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; Center for Evidence-based Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
• Int J Surg. 2015 Oct 1; 22: 79-85.

BackgroundAlthough 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.MethodsPubMed, 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.ResultsWe 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.ConclusionAdministration 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.Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

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