Prevention of Severe Postoperative Pain After Breast Surgery Using Opioid-Sparing Analgesia With Intraoperative and Drain-Based Ropivacaine Infiltration: A Prospective Observational Study

Background and aim: Breast surgery is frequently associated with high postoperative pain, which if not adequately managed can delay recovery and increase the risk of chronic postsurgical pain. This study evaluated whether perioperative opioid application and/or incisional infiltration with long-acting local anesthetics can improve postoperative pain control as part of an effective preventive strategy. Study Design and methods: A total of 536 consecutive patients undergoing breast surgery at Jena University Hospital were prospectively evaluated on the first postoperative day using a standardized pain questionnaire as part of the QUIPS (Quality Improvement in Postoperative Pain Management) project. Analgesic strategies were introduced sequentially in addition to the standard postoperative pain management (group A, first 9 months): addition of prophylactic oxycodone (group B, 17 months), combined oxycodone and wound infiltration with ropivacaine (group D, 4 months), and finally ropivacaine alone (group C, 6 months). Results: All three intervention groups showed significant improvements over standard care, with more patients pain-free at 24 hours (group A: 9.5%, B: 18.5%, C: 16.3%, D: 25.6%; p=0.01), fewer requiring opioids on demand (A: 26.5%, B: 15.9%, C: 4.1%, D: 4.7%; p<0.05), and a significantly delayed first opioid request. The incidence of nausea and vomiting was significantly lower in the ropivacaine-only group compared to other regimens (p=0.03). Ropivacaine infiltration alone (group C) was associated with the fewest opioid-related side effects. Conclusion: Intraoperative and drain-based ropivacaine wound infiltration, alone or in combination with pre-emptive oxycodone, effectively reduced acute postoperative pain and opioid requirements after breast surgery, while reducing opioid-related side effects like nausea and vomiting. As part of a multimodal, opioid-sparing strategy, this technique demonstrated favourable patient-reported outcomes and may contribute to faster recovery, fewer side effects, and improved patient-reported satisfaction. These findings support the clinical relevance of preventive local anaesthetic techniques in breast surgery.