38 [P]ostoperative [A]nalgesia and [I]nvestigating [N]arcotics in Breast Cancer Patients; Protocol BHWGI 24-01: PAIN

Background

Postoperative pain management strategies vary considerably among health care providers and even across countries. Postoperative opioid exposure has been identified as a significant contributing factor to the opioid epidemic, serving as an initial trigger in the pathway toward opioid dependence and misuse. The goal of this study was to assess real-world postoperative pain trajectories as well as the relationship between pain severity and opioid consumption following breast surgery.

Materials and Methods

This prospective multicenter observational cohort study included patients who underwent breast surgery between November 2024 and October 2025. The standard analgesic protocol consisted of paracetamol 500 mg administered every 4 to 6 hours, with nonsteroidal anti-inflammatory drugs (NSAIDs) prescribed on an as-needed basis at 6- to 12-hour intervals. None of the patients had pre- or intraoperative nerve block. Postoperative pain intensity was assessed using the visual analog scale (VAS) on postoperative days 1, 7, 15, and 30. The highest reported VAS score within the first 30 postoperative days was defined as VASmax and categorized as mild (VAS score, 1-3), moderate (VAS, 4-6), or severe (VAS ≥7) pain. Group comparisons were performed using the Kruskal-Wallis or Mann-Whitney U tests. Longitudinal changes in pain scores were analyzed using the Friedman test.

Results

A total of 433 patients were included in the analysis, with a median age of 54 years (46-65). Breast-conserving surgery (BCS) with or without level 1 oncoplastic techniques (OPT) was the most common procedure (n = 235; 54.3%). Sentinel lymph node biopsies were performed on the majority of patients (n = 319; 73.7%). Median VAS scores declined significantly over time, from 2 (2-4) on postoperative day 1 to 0 (0-0) on day 30 (P <.001; Figure). The median duration of postoperative analgesic use was 7 days (IQR, 4-10). Across all postoperative time points, patients undergoing BCS with or without level 1 OPT reported consistently lower VAS scores compared with those undergoing mastectomies or level 2/3 OPT (P <.001). Bilateral surgery and higher clinical N stage were associated with higher postoperative pain at all evaluated time points (P <.05). Neoadjuvant chemotherapy was associated with higher pain during the early postoperative period but not on day 30. Pain intensity did not differ significantly according to axillary intervention type or clinical T stage. Severe postoperative pain (VASmax ≥7) was observed in 7.4% of patients. Opioid analgesics were required in 2.5% (n = 11). Opioid use was significantly associated with receipt of neoadjuvant chemotherapy (P = .019) and level 2 to 3 OPT (P = .005).

Conclusion

Most of the patients in this cohort had pain levels that could be controlled with nonopioid analgesic techniques, and postoperative severe pain was uncommon.