Regional anesthesia in breast surgery: An Italian expert consensus – Part 2: Results from a network meta-analysis evaluating 103 randomized controlled trials on regional anesthesia techniques for mastectomy with or without axillary clearance

ABSTRACT Regional anesthesia techniques are increasingly used to improve analgesia and reduce opioid consumption after breast surgery. Several approaches have been proposed, including paravertebral block and different fascial plane blocks, but their comparative effectiveness remains uncertain. This network meta-analysis (NMA) aimed to compare the efficacy and safety of regional anesthesia techniques in patients undergoing mastectomy with or without axillary clearance. A systematic review and NMA of randomized controlled trials were conducted according to established methodological guidelines. Studies evaluating regional anesthesia techniques in patients undergoing mastectomy were included. Outcomes assessed were intraoperative opioid consumption, 24-hour postoperative morphine milligram equivalents (MMEs), pain at rest and with movement at 12 and 24 hours, postoperative nausea and vomiting (PONV), use of rescue analgesics, and the incidence of complications such as pneumothorax and local anesthetic systemic toxicity (LAST). Regional anesthesia techniques were associated with improved analgesic outcomes compared with LA infiltration or no regional block. Paravertebral block showed the most consistent benefit across outcomes, particularly for opioid consumption and postoperative pain. Fascial plane blocks demonstrated comparable performance to paravertebral blocks for most outcomes, although paravertebral blocks showed superior results for pain on movement. LA infiltration alone or the absence of regional anesthesia performed worse across most outcomes. Serious complications were rarely reported. Paravertebral block appears to provide the most consistent analgesic benefit for mastectomy when performed by experienced practitioners. Fascial plane blocks represent a reasonable alternative when a paravertebral block is not feasible. Simple surgical infiltration alone appears insufficient for optimal analgesia in major breast surgery.

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Journal
Saudi Journal of Anaesthesia
Published
2026-07-01
DOI
https://doi.org/10.4103/sja.sja_226_26
Primary Topic
Anesthesia and Pain Management
Type
article
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article

Regional anesthesia in breast surgery: An Italian expert consensus – Part 2: Results from a network meta-analysis evaluating 103 randomized controlled trials on regional anesthesia techniques for mastectomy with or without axillary clearance

Federico Bizzarri, Giuseppe Pascarella, Gabriele Melegari, Diego Marandola et al.
Saudi Journal of Anaesthesia
Anesthesia and Pain Management
article

Regional anesthesia in breast surgery: An Italian expert consensus – Part 2: Results from a network meta-analysis evaluating 103 randomized controlled trials on regional anesthesia techniques for mastectomy with or without axillary clearance

Federico Bizzarri, Giuseppe Pascarella, Gabriele Melegari, Diego Marandola, Domenico P. SANTONASTASO, Antonio Coviello, Annalisa Curcio, Tommaso Tonetti, Secondo Folli, Elisabetta Pusceddu, Maria Grazia Frigo, Annabella de Chiara, Giuseppe Lubrano, Vanni Agnoletti, Fabrizio Fattorini, Mario Tedesco, Andrea Tognù, Dario Pietrantozzi, Pierfrancesco Fusco, Maria Caterina Pace, Marco Rispoli, Giuseppe Sepolvere, Paolo Scimia, Tommaso Pettenuzzo, Cristiano D’Errico, Eros Pilia, Giorgia Boschetto, Giorgio Ranieri, Francesco Coppolino, Nicola Rocco, Alessandra GENTILI, Federico Piccioni, Fabio Costa, Moana R. Nespoli, Antonio Clemente, Annalisa Boscolo, Dario M. Mattiacci, Claude T. Bagaphou, Alessandro De Cassai, Alessandra Morelli
article en

Abstract

ABSTRACT Regional anesthesia techniques are increasingly used to improve analgesia and reduce opioid consumption after breast surgery. Several approaches have been proposed, including paravertebral block and different fascial plane blocks, but their comparative effectiveness remains uncertain. This network meta-analysis (NMA) aimed to compare the efficacy and safety of regional anesthesia techniques in patients undergoing mastectomy with or without axillary clearance. A systematic review and NMA of randomized controlled trials were conducted according to established methodological guidelines. Studies evaluating regional anesthesia techniques in patients undergoing mastectomy were included. Outcomes assessed were intraoperative opioid consumption, 24-hour postoperative morphine milligram equivalents (MMEs), pain at rest and with movement at 12 and 24 hours, postoperative nausea and vomiting (PONV), use of rescue analgesics, and the incidence of complications such as pneumothorax and local anesthetic systemic toxicity (LAST). Regional anesthesia techniques were associated with improved analgesic outcomes compared with LA infiltration or no regional block. Paravertebral block showed the most consistent benefit across outcomes, particularly for opioid consumption and postoperative pain. Fascial plane blocks demonstrated comparable performance to paravertebral blocks for most outcomes, although paravertebral blocks showed superior results for pain on movement. LA infiltration alone or the absence of regional anesthesia performed worse across most outcomes. Serious complications were rarely reported. Paravertebral block appears to provide the most consistent analgesic benefit for mastectomy when performed by experienced practitioners. Fascial plane blocks represent a reasonable alternative when a paravertebral block is not feasible. Simple surgical infiltration alone appears insufficient for optimal analgesia in major breast surgery.

Saudi Journal of AnaesthesiaVol. 20(3)
University of Padua (IT), University of Cagliari (IT), University of Campania "Luigi Vanvitelli" (IT), Azienda Sanitaria Unità Locale di Reggio Emilia (IT), Casa di Cura San Michele (IT), San Salvatore Hospital (IT), Città di Castello Hospital (IT), Sorrento Therapeutics (United States) (US), Ospedale di Santo Spirito (IT), Fatebenefratelli Hospital (IT), Azienda Ospedaliero-Universitaria di Modena (IT), CSI Piemonte (IT), Istituto Ortopedico Gaetano Pini (IT), Ospedale “M. Bufalini” di Cesena (IT), Ospedale G.B. Morgagni - L.Pierantoni (IT), Nini Hospital (LB), Ospedale Monaldi (IT), Istituto Nazionale di Fisica Nucleare, Laboratori Nazionali di Frascati (IT), Campus Bio Medico University Hospital (IT), Ospedale San Giuseppe (IT), Ospedale Buon Consiglio Fatebenefratelli (IT), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), IRCCS Humanitas Research Hospital (IT), Azienda Ospedaliera G. Brotzu (IT), University of Naples Federico II (IT), University of Bologna (IT)
Good health and well-being
Openalex Percentile: Top 5%
Anesthesia and Pain Management
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