Prescription of pregabalin for prevention of acute post-mastectomy pain syndrome (APMPS): a systematic review and meta-analysis of randomized controlled trials.

Abstract

<h4>Background</h4>Mastectomy is generally considered the most effective treatment option for breast cancer. However, it is linked to a variety of complications that contribute to an elevated morbidity. Acute Post Mastectomy Pain Syndrome (APMPS) is 2 months or more of neuropathic pain after mastectomy. Pregabalin, a powerful central nervous system inhibitor is commonly prescribed for the relief of neuropathic pain. This study evaluates its efficacy in curing neuropathic pain and enhancing mastectomy pain management.<h4>Methods</h4>We conducted a comprehensive literature search comparing pregabalin with placebo using relevant syntaxes. Postoperative acute pain scores, 24-hour morphine use, dizziness, and sedation were evaluated. A <i>P</i>-value of less than 0.05 was considered statistically significant.<h4>Results</h4>Ten studies with a total of 719 patients were included. The pregabalin group exhibited significantly lower acute pain scores compared to the placebo group (standard mean difference: -0.61; 95% confidence interval: -1.02 to -0.20; <i>P</i> < 0.01). No statistically significant differences were observed in 24-hour morphine consumption (standardized mean difference, -2.74; 95% CI, -6.27; -0.79, <i>P</i> > 0.05, <i>I</i> ² = 97.6%), dizziness (RR, 1.49; 95% CI, 0.82; 2.71, <i>P</i> > 0.05, <i>I</i> ² = 1.0%) or sedation (RR, 1.38; 95% CI, 0.11; 17.84, <i>P</i> > 0.05, <i>I</i> ² = 0.0%) between the groups. The acute pain scores showed significant heterogeneity, with an <i>I</i> ² value of 78.6%.<h4>Discussion</h4>This meta-analysis indicates that pregabalin may be effective for managing APMPS. However, due to the heterogeneity and limitations of the included studies, the findings should be interpreted with caution. Future research should focus on larger sample sizes, incorporating potential moderating factors to more precisely determine pregabalin's role in APMPS.