Description of studies

Description of studies

Literature search

Systematic review of the literature from 1966–May 2006 using MEDLINE and EmBASE, following the protocol of the Cochrane Collaboration: Non-cosmetic Breast Surgery search terms

• Inclusion of randomised studies in English, assessing analgesic interventions in non-cosmetic breast surgery in adults, and reporting pain on a linear analogue, verbal or numerical rating scale
• Primary outcome measure: postoperative pain scores
• Secondary outcome measure: supplemental analgesic requirements, other recovery outcomes (adverse effects, functional recovery)
• Identification of 99 studies of peri-operative interventions for postoperative pain following breast surgery
• 42 studies included: Non-cosmetic Breast Surgery Included References
• 57 studies excluded
• The most common reasons for exclusion were that pain scores were not reported (29 studies), or the study combined data from mixed surgery groups (10 studies) without an identifiable breast surgery subgroup, or the type of surgery was inappropriate (8 studies): Table 1: Non-cosmetic Breast Surgery Reasons for Exclusion

Study quality assessments, levels of evidence and grades of recommendation

Recommendations are graded according to the overall level of evidence (LoE) on which the recommendations are based, which is determined by the quality and source of evidence: Levels of evidence and grades of recommendation in PROSPECT reviews (from 2006)

Click here for quality scores and levels of evidence for included procedure-specific studies: Table 3: Non-cosmetic Breast Surgery May 2006 Quality Scoring + Levels of Evidence

Quantitative analyses

Overall, few meta-analyses could be performed that used data from more than two studies. This is because there are a limited number of studies of homogeneous design that report similar outcome measures. Therefore, the majority of the procedure-specific evidence was assessed only qualitatively.

Transferable evidence

Transferable evidence of analgesic efficacy from comparable procedures or evidence of other outcomes, such as adverse effects, has been included to support the procedure-specific evidence where this is insufficient to formulate the recommendations.

Several studies that were identified in the literature search included patients undergoing undefined or cosmetic breast surgery, or reported data pooled from patients undergoing mixed surgical procedures including breast surgery. Such studies are excluded from the procedure-specific systematic review, but have been used as additional transferable evidence in cases where the Working Group considered it appropriate.