Perioperative Prevention of Post-Mastectomy Pain Syndrome: Literature Review

Chronic Pain Syndrome After Breast Cancer Surgery, defined as Postmastectomy Pain Syndrome (PMPS), is a condition in which, according to statistics, about 60% of patients experience low-intensity pain for three to six months after surgery in the intervention area, while 15-25% of patients suffer from moderate or high-intensity pain. The objective of this review is to analyze literature sources containing relevant data on anesthesia and analgesia methods used to prevent PMPS, as well as studies on new perioperative and postoperative PMPS prevention techniques. The authors conducted a search and review of literature in the PubMed, Ovid MEDLINE, Google Scholar, and ScienceDirect databases. The review included studies published between 2014 and 2024, where the study population consisted of adult female patients who underwent mastectomy for breast cancer treatment or prophylactic risk reduction, as well as data on pharmacological and regional anesthesia methods for PMPS prevention over 3 months or more after surgery. Regional nerve blocks as a method of intraoperative anesthesia demonstrated high efficacy and good analgesic effects during mastectomy, reducing the need for opioid analgesics. However, data on their effectiveness in preventing PMPS remain inconclusive. Studies on the efficacy of Pectoral Nerve Block (PECS II) in reducing post-breast cancer surgery pain found no statistically significant differences in PMPS incidence at 3 and 6 months post-surgery between patient groups. Compared to ketamine and lidocaine, pregabalin showed greater efficacy in preventing chronic pain syndrome, though its benefits were primarily short-term, and long-term effects require further research. Physiotherapy methods did not lead to significant improvements compared to traditional approaches, which may be due to small sample sizes in the studies. Psychotherapeutic interventions, such as cognitive-behavioral therapy (CBT) and hypnosis, proved effective in reducing pain perception and stress levels during the perioperative period.