title: The analgesic effect of wound infiltration with local anaesthetics after breast surgery: a qualitative systematic review.
abstract: BACKGROUND
  Wound infiltration with local anaesthetics is commonly used during breast surgery in an attempt to reduce post-operative pain and opioid consumption. The aim of this review was to evaluate the effect of wound infiltration with local anaesthetics compared with a control group on post-operative pain after breast surgery.
  
  
  METHODS
  A systematic review was performed by searching PubMed, Google Scholar, the Cochrane database and Embase for randomised, blinded, controlled trials of wound infiltration with local anaesthetics for post-operative pain relief in female adults undergoing breast surgery. The analgesic effect was evaluated in a qualitative analysis by assessment of significant difference between groups (P < 0.05) in pain scores and supplemental analgesic consumption.
  
  
  RESULTS
  Ten trials including 699 patients were included in the final analysis. Three trials investigated mastectomy, four trials partial or segmental mastectomy, and three trials breast reduction, excision of benign lump and unspecified breast surgery, respectively. Six trials demonstrated a small and short-lasting, but statistically significant reduction of post-operative pain scores, and four trials observed a statistically significant reduction in post-operative, supplemental opioid consumption that was, however, of limited clinical relevance.
  
  
  CONCLUSIONS
  Wound infiltration with local anaesthetics may have a modest analgesic effect in the first few hours after surgery. Pain after breast surgery is, however, generally mild to moderate, and other non-invasive analgesic methods may be preferable in this surgical population.
authors.affiliation: Department of Anaesthesia 4231, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark.
authors.forename: N
authors.initials: N
authors.lastname: Byager
authors.forename: M S
authors.initials: MS
authors.lastname: Hansen
authors.forename: O
authors.initials: O
authors.lastname: Mathiesen
authors.forename: J B
authors.initials: JB
authors.lastname: Dahl
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D001940:Breast / Q000601:surgery*; D005260:Female; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014947:Wounds and Injuries
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local