ArticleAnnals of surgical oncology2026
Multi-agent Preemptive Analgesia Reduces Pain and Shortens Hospital Stay After Mastectomy with Reconstruction.
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- ASO Author Reflections: Atypical Breast Lesions on Core Needle Biopsy: Defining a Low-Risk Population to Guide Selective Surgical Excision.Annals of surgical oncology · 2026Article
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9 authors.
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Abstract
backgroundA cornerstone of enhanced recovery after surgery (ERAS) pathways is preemptive analgesia-the administration of analgesic medications prior to incision to blunt central sensitization and postoperative pain. We now evaluate the efficacy of different preoperative analgesia regimens for reducing patient-reported pain, opioid consumption, and postoperative length of stay (LOS).
methodsWe performed a retrospective review of consecutive women undergoing mastectomy with immediate implant/tissue-expander reconstruction from January 2023 through June 2024. Preoperative analgesia regimens were acetaminophen only (A-only); acetaminophen and gabapentin (A+G); acetaminophen, gabapentin, and celecoxib (A+G+C); or no analgesics (no meds).
resultsMean postoperative LOS for 537 mastectomy with reconstruction patients was 6.2 hours (range 0.9-75), median 3.9 hours. 98.5% of patients received a paravertebral block. The distribution of preoperative oral analgesics was no meds, 70 (13.0%); A-only, 298 (55.5%); A+G, 125 (23.3%); and A+G+C, 44 patients (8.2%). Same-day discharge was highest with A+G+C (100%) versus A+G (90%), A-only (89%), and no preoperative medications (77%) (p < 0.001). On multivariable analysis, compared with a 9.0 hour mean LOS with no medications, A-only reduced LOS by 2.9 hours (p = 0.004), A+G by 3.0 hours (p = 0.007), and A+G+C by 4.5 hours (p = 0.023). On multivariable analysis, A+G+C was also independently associated with lower maximum pain scores (β = - 2.24, p < 0.001) compared with patients receiving no preoperative analgesic medications. DISCUSSION: Our findings demonstrate that even with a preoperative paravertebral block, preemptive oral analgesics reduce pain, and LOS after mastectomy with reconstruction. These data support the routine use of a standardized multi-agent oral analgesia regimen in mastectomy and reconstruction procedures.
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