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


CONCLUSIONS
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.
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.
Ka-Wai
KW
Tam
Department of Anesthesiology, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Shin-Yan
SY
Chen
Department of Nursing, College of Medicine and Nursing, HungKuang University, Taiwan.
Tsai-Wei
TW
Huang
Center for Evidence-based Health Care, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan.
Chao-Chun
CC
Lin
Division of General Surgery, Department of Surgery, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan.
Chih-Ming
CM
Su
Division of General Surgery, Department of Surgery, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan.
Ching-Li
CL
Li
School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Yuan-Soon
YS
Ho
Division of General Surgery, Department of Surgery, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan. Electronic address: kelvintam@h.tmu.edu.tw.
Wan-Yu
WY
Wang
Division of General Surgery, Department of Surgery, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taiwan. Electronic address: 13259@s.tmu.edu.tw.
Chih-Hsiung
CH
Wu
D000577:Amides / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000601:surgery*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D000077212:Ropivacaine
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine
Breast cancer; Bupivacaine; Local anesthesia; Meta-analysis; Postoperative pain; Ropivacaine; Wound infiltration