Perioperative prevention of postmastectomy pain syndrome: a review

Postmastectomy pain syndrome, defined as chronic pain following breast cancer surgery, affects approximately 60% of patients with mild-intensity pain in the surgical area lasting for three to six months after surgery, whereas 15%–25% experience moderate to severe pain. The aim of this review was to analyze the publications containing current data on anesthesia and analgesia techniques used for postmastectomy pain syndrome prevention, as well as to evaluate studies focusing on new perioperative and postoperative preventive strategies. A scientific data search was conducted using the PubMed, Ovid MEDLINE, Google Scholar, and ScienceDirect databases. The review included studies published from 2014 to 2024, with study populations comprising adult female patients who had undergone mastectomy for breast cancer or as a prophylactic measure to reduce the risk of cancer. The analysis also incorporated data on pharmacological and regional anesthetic approaches used to prevent postmastectomy pain syndrome for three months or longer postoperatively. Regional nerve blocks used as intraoperative anesthesia technique have demonstrated high efficacy and a good analgesic effect during mastectomy, reducing the need for opioid analgesics; however, their effectiveness in postmastectomy pain syndrome prevention remains inconclusive. Studies evaluating the effectiveness of pectoral nerve block (PECs II) for reducing the incidence of pain after breast cancer surgery did not reveal statistically significant differences in the frequency of postmastectomy pain syndrome at 3 and 6 months postoperatively between patient groups. Compared with ketamine and lidocaine, pregabalin was superior in preventing chronic pain syndrome. However, it shows short-term efficacy, whereas its long-term effects have yet to be investigated. Physiotherapeutic methods did not demonstrate significant improvements compared to standard methods, possibly due to small sample sizes in the studies. Psychotherapeutic techniques, such as cognitive behavioral therapy and hypnosis, proved effective in reducing pain perception and stress during the perioperative period.