Evidence-Based Guideline on the Prevention and Management of Perioperative Pain for Breast Cancer Peoples in a Low-Resource Setting: A Systematic Review Article

Table 2

The summary of recommendation and strength of evidence for perioperative pain management in breast cancer patients.

S. No.	Pain management methods			Grades of recommendation	Strength of evidence
1	Preoperative pain management approaches
	Nonpharmacologic methods	Psychological preparation		A	1b
		Adequate sleep		B	2b
		Music therapy		A	1a
	Pharmacologic methods; systemic analgesia	Anticonvulsant	Gabapentin	A	1a
			Deluxetine	A	1b
			Pregabalin	A	1a
		Ketamine		A	1b
		Dexamethasone 8 mg		A	1b
2	Intraoperative pain management using the pharmacological methods
	Systemic analgesia	IV lidocaine 3 mg/kg with magnesium 50 mg/kg		A	1b
		Esmolol		A	1b
		Local anesthesia wound infiltration with ropivacaine or bupivacaine		A	1a
		NSAIDs (diclofenac or ibuprofen)		A	1a
		Opioid free anesthesia		A	1b
	Regional technique	Paravertebral extended block (with clonidine, fentanyl, or ketamine) + TIVA		A	1a
		Combined PECS I and PECS II block + TIVA		A	1a
		Thoracic epidural anesthesia + TIVA		A	1a, 1b
		Serratus anterior plane block + MMA + TIVA		A	1a
		Erector spinae block + MMA + TIVAs		A	1b
3	Postoperative pain management
	Nonpharmacologic methods	Acupuncture		B	1c
		Physical exercise		A	1a
		Music therapy		A	1a
		Foot massage		B	1c
	Pharmacologic interventions	Extended paravertebral (with or without catheter)		A	1a
		Thoracic epidural catheter		A	1a
		Additives: Clonidine, fentanyl, or ketamine		A	1b
		NSAIDs		A	1a