Regional anesthesia in breast surgery: An Italian expert consensus - Part 1: Methodology and Delphi strategy

Area of Science:

• Anesthesiology
• Surgical Pain Management
• Regional Anesthesia

Background:

• Breast surgery frequently causes significant acute and chronic postoperative pain, impacting patient recovery and quality of life.
• Current clinical practice for regional anesthesia in breast surgery is inconsistent and lacks clear guidelines.
• Regional anesthesia is a key component of multimodal analgesic strategies for breast surgery.

Purpose of the Study:

• To establish a multidisciplinary, evidence-based consensus on the application of regional anesthesia in breast surgery.
• To address the heterogeneity in clinical practice and provide clear guidance for anesthesiologists and surgeons.
• To develop graded consensus statements to support standardized clinical decision-making.

Main Methods:

• An expert panel comprising anesthesiologists and breast surgeons was convened.
• A four-round Delphi method was used to refine 24 PICO-formulated questions on regional anesthesia in breast surgery.
• Systematic reviews and network meta-analyses were conducted to evaluate evidence for finalized questions.

Main Results:

• Eleven clinically relevant and clear PICO questions were finalized after four Delphi rounds.
• Key areas addressed include acute/chronic pain control, block safety in anticoagulated patients, and awake surgery.
• The finalized questions will guide systematic reviews and the development of graded consensus statements.

Conclusions:

• This project created a transparent, multidisciplinary framework for regional anesthesia in breast surgery.
• The consensus statements will be graded by evidence strength.
• The findings will form the basis for future guidelines and standardized clinical decision-making in breast surgery anesthesia.