Local Anesthetic Infiltration for Pain Control in Aesthetic Breast Reduction Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Aesthetic breast surgeries, including breast reduction, are commonly performed surgical procedures associated with postoperative pain. Pain control is essential to patient comfort, satisfaction, and early recovery. This systematic review is the first to conduct both qualitative and quantitative analysis to evaluate the efficacy and safety of local anesthetic infiltration in reducing pain after breast reduction surgeries. METHODS: This systematic review is registered in PROSPERO, assessed for bias using the RoB2 tool, and follows the PRISMA guidelines. A full electronic search was performed in different databases for all clinical papers on adult female patients undergoing cosmetic breast reduction surgery who were given local anesthetic infiltration for postoperative pain relief. RESULTS: A systematic review of five randomized clinical trials with a total of 191 patients found that local anesthetic infiltration significantly reduces postoperative pain in breast reduction surgery, reduces opioid consumption, and improves patient outcomes. A meta-analysis of two trials reported the mean VAS score for postoperative pain in the local anesthetic and placebo groups. CONCLUSION: A systematic review and a meta-analysis show a significant reduction in postoperative pain following local anesthetic infiltration, but further research is needed to understand its effectiveness and potential adverse effects. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The dual role of MiR-210 in the aetiology of cancer: A focus on hypoxia-inducible factor signalling.

Tumorigenesis exemplifies the complex process of neoplasm origination, which is characterised by somatic genetic alterations and abnormal cellular growth. This multidimensional phenomenon transforms previously dormant cells into malignant equivalents, resulting in uncontrollable proliferation and clonal expansion. Various elements, including random mutations, harmful environmental substances, and genetic predispositions, influence tumorigenesis's aetiology. MicroRNAs (miRNAs) are now recognised as crucial determinants of gene expression and key players in several biological methods, including oncogenesis. A well-known hypoxia-inducible miRNA is MiR-210, which is of particular interest because of its complicated role in the aetiology of cancer and a variation of physiological and pathological situations. MiR-210 significantly impacts cancer by controlling the hypoxia-inducible factor (HIF) signalling pathway. By supporting angiogenesis, metabolic reprogramming, and cellular survival in hypoxic microenvironments, HIF signalling orchestrates adaptive responses, accelerating the unstoppable development of tumorous growth. Targeting several components of this cascade, including HIF-1, HIF-3, and FIH-1, MiR-210 plays a vital role in modifying HIF signalling and carefully controlling the HIF-mediated response and cellular fates in hypoxic environments. To understand the complexities of this relationship, careful investigation is required at the intersection of MiR-210 and HIF signalling. Understanding this relationship is crucial for uncovering the mechanisms underlying cancer aetiology and developing cutting-edge therapeutic approaches. The current review emphasises MiR-210's significance as a vital regulator of the HIF signalling cascade, with substantial implications spanning a range of tumor pathogenesis.