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Prevalence and intensity of persistent post-surgical pain following breast cancer surgery: a systematic review and meta-analysis of observational studies.

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机构： [1]Department of Anesthesia, McMaster University, Hamilton, ON, Canada [2]Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada [3]Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China [4]Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada [5]Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, Haryana, India [6]Division of Plastic Surgery, University of Toronto, Toronto, ON, Canada [7]Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada [8]Department of Diagnostic Radiology, University of Toronto, Toronto, ON, Canada [9]Department of Anesthesia and Critical Care, University Hospital of Toledo, Toledo, Spain [10]Department of Surgery, Queen’s University, Kingston, ON, Canada [11]Wayne State University School of Medicine, Detroit, MI, USA [12]Department of Community Medicine, North DMC Medical College, New Delhi, India [13]Department of Family Medicine, McMaster University, Hamilton, ON, Canada [14]Department of Medicine, University of Toronto, Toronto, ON, Canada [15]Department of Surgery, McMaster University, Hamilton, ON, Canada [16]Department of Anesthesia, University of Toronto, Toronto, ON, Canada [17]School of Nursing, McMaster University, Hamilton, ON, Canada [18]Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, ON, Canada and [19]Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada

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关键词： breast cancer chronic postoperative pain intensity meta-analysis persistent post-surgical pain prevalence systematic review

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The prevalence and intensity of persistent post-surgical pain (PPSP) after breast cancer surgery are uncertain. We conducted a systematic review and meta-analysis to further elucidate this issue. We searched MEDLINE, Embase, CINAHL, and PsycINFO, from inception to November 2018, for observational studies reporting persistent pain (≥3 months) after breast cancer surgery. We used random-effects meta-analysis and the Grading of Recommendations, Assessment, Development and Evaluations approach to rate quality of evidence. We included 187 observational studies with 297 612 breast cancer patients. The prevalence of PPSP ranged from 2% to 78%, median 37% (inter-quartile range: 22-48%); the pooled prevalence was 35% (95% confidence interval [CI]: 32-39%). The pooled pain intensity was 3.9 cm on a 10 cm visual analogue scale (95% CI: 3.6-4.2 cm). Moderate-quality evidence supported the subgroup effects of PPSP prevalence for localized pain vs any pain (29% vs 44%), moderate or greater vs any pain (26% vs 44%), clinician-assessed vs patient-reported pain (23% vs 36%), and whether patients underwent sentinel lymph node biopsy vs axillary lymph node dissection (26% vs 43%). The adjusted analysis found that the prevalence of patient-reported PPSP (any severity/location) was 46% (95% CI: 36-56%), and the prevalence of patient-reported moderate-to-severe PPSP at any location was 27% (95% CI: 10-43%). Moderate-quality evidence suggests that almost half of all women undergoing breast cancer surgery develop persistent post-surgical pain, and about one in four develop moderate-to-severe persistent post-surgical pain; the higher prevalence was associated with axillary lymph node dissection. Future studies should explore whether nerve sparing for axillary procedures reduces persistent post-surgical pain after breast cancer surgery. Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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医学

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最新[2023]版：

大类 | 1 区

医学

小类 | 1 区麻醉学

第一作者：

第一作者机构： [1]Department of Anesthesia, McMaster University, Hamilton, ON, Canada [2]Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada [3]Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China

通讯作者：

通讯机构： [1]Department of Anesthesia, McMaster University, Hamilton, ON, Canada [2]Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada [3]Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China

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Prevalence and intensity of persistent post-surgical pain following breast cancer surgery: a systematic review and meta-analysis of observational studies.

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