Multimodal analgesia and antiemetic regimen in breast cancer surgery. A prospective cohort study with patient-reported outcomes

Despite recommendations for multimodal pain management in breast cancer surgery patients, no universally accepted regimen exists. This study aimed to evaluate the clinical efficacy of a new peri- and postoperative multimodal analgesic and antiemetic regimen in a prospective cohort of day-case breast cancer patients during the first postoperative week. The multimodal regimen included paracetamol, NSAIDs, local infiltration analgesia, dexamethasone, ondansetron, and opioids as needed for pain management. Women diagnosed with breast cancer and scheduled for day-case unilateral lumpectomy or mastectomy, with or without lymphadenectomy, were included. Participants reported daily pain levels, analgesic use, and adverse events in a seven-day diary. A total of 211 patients completed the diary and were included in the analysis: 170 underwent lumpectomy, and 41 mastectomy. Daily average pain levels on postoperative day (POD) 1-7 was low (median NRS 1-2). On POD1, daily worst pain was median (interquartile range (IQR)): NRS 3 (1-5) (lumpectomy) and NRS 3 (0-6) (mastectomy). During POD2-7, daily worst pain was median NRS 1-2 (lumpectomy) and NRS 2 (mastectomy). On POD1, pain during 90-degree arm abduction was median (IQR) NRS 2 (0-3) (lumpectomy) and NRS 2 (1-6) (mastectomy). Median NRS from POD2-7 was 1 (lumpectomy) and 1-2 (mastectomy). Opioid use and incidence of postoperative nausea and vomiting were low. Patients undergoing day-case breast cancer surgery with a new standardised multimodal non-opioid analgesic and antiemetic regimen reported low pain scores, minimal opioid use and a relatively low incidence of adverse events during the first postoperative week. ClinicalTrials.gov (NCT04875559), april 2021