Comparison of Two Postoperative Care Strategies After Breast Surgery

Postoperative pain following breast surgery can negatively affect patients' recovery and overall experience after hospital discharge. Effective postoperative analgesia may require not only appropriate pharmacological treatment but also adequate patient education regarding pain management and the use of non-pharmacological measures.

This pilot prospective randomized clinical trial is designed to evaluate whether a comprehensive postoperative analgesia strategy incorporating patient education can improve pain control and quality of recovery compared with standard postoperative analgesic management in adult women undergoing breast surgery.

The intervention strategy combines patient education, discussion of postoperative pain management, non-pharmacological measures, and a multimodal pharmacological analgesic regimen. The control strategy consists of standard postoperative analgesic management and written postoperative instructions.

Participants will be followed from the preoperative period through 90 days after surgery to evaluate postoperative pain, quality of recovery, and other patient-reported outcomes.

• Patient Education (Behavioral): Structured patient education regarding postoperative pain management, including discussion of the analgesic strategy and appropriate use of pharmacological and non-pharmacological pain management measures.
• Paracetamol (Drug): Paracetamol 1 g orally three times daily (3 g/day)
• Dexketoprofen (Drug): Dexketoprofen 50 mg is administered intravenously every 12 hours during the first 48 hours postoperatively. It is then switched to oral dexketoprofen 25 mg every 12 hours for 3 days, followed by use as needed for pain until 7-14 days after surgery.
• Pregabalin (Drug): Pregabalin 25-75 mg is administered orally every 12 hours for 30 days as part of the multimodal postoperative analgesic regimen
• Tramadol (Drug): Tramadol 50-100 mg IV postoperatively as rescue therapy (maximum dose 300 mg/day). If the patient received tramadol during the postoperative period, oral tramadol 50 mg was continued as needed for pain for 4-7 days (maximum daily dose 300 mg)

Primary outcomes

• Postoperative Pain Intensity [Postoperative day 1, day 7, 1 month, and 3 months after surgery]: Postoperative pain intensity assessed using the Numerical Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain)
• Quality of Recovery [Postoperative day 1]: Quality of recovery assessed using the Quality of Recovery-15 (QoR-15) questionnaire. Total scores range from 0 to 150, with higher scores indicating better quality of recovery

Secondary outcomes

• Incidence of Chronic Neuropathic Pain [Preoperatively, 1 month, and 3 months after surgery]: Incidence of chronic neuropathic pain assessed using the PainDETECT questionnaire
• Patients' Emotional Status [Preoperatively]: Assessment of patients' emotional status using the Patient Health Questionnaire-9 (PHQ-9)
• Incidence of Postoperative Opioid Use [From surgery through 3 months postoperatively]: Postoperative opioid use recorded as a binary variable (yes/no), indicating whether participants received opioids for postoperative pain management during hospitalization
• Incidence of Adverse Events [From surgery through 3 months postoperatively]: Incidence of adverse events associated with the postoperative analgesic regimens, including dizziness, nausea, vomiting, and other adverse effects reported or observed during the study

Sex: Female, ages: 18 Years to any

Inclusion Criteria:

* Age ≥ 18 years
* ASA physical status classification I-III
* Provision of written informed consent
* Ability to be contacted by telephone

Exclusion Criteria:

* Hypersensitivity to any of the medications used in the study
* Severe hepatic or renal dysfunction
* Pregnancy
* History of epileptic seizures
* Severe psychiatric disorder (e.g., active psychosis or severe depression) affecting their ability to cooperate
* Underwent a second surgical procedure before completion of the 3-month follow-up period

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