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136 Breast pain
Pregnancy: acetaminophen (650–1000 mg PO q4–6 h), with as-needed opioid
(e.g. hydrocodone 5–10 mg PO q4–6 h)
Pediatric:
n NSAID (e.g. ketorolac 0.25 mg/kg PO q6 h)
n acetaminophen 15 mg/kg PO q4–6h
Special circumstances:
n susceptibility to GI NSAID side effects and wish to avoid opioids: celecoxib
(400 mg PO followed by 200 mg PO QD–BID)
n nipple blanching/vasospasm-mediated mastalgia: once-daily PO sustained
release nifedipine 30 mg
CYCLIC MASTALGIA
First line:
n NSAID (e.g. ibuprofen 400–600 mg PO q6–8h)
n topical diclofenac (2% gel, 11.6 mg/g, 50 mg diclofenac component
TID)
Reasonable:
n danazol (200 mg PO daily)
n opioids (e.g. hydromorphone 5–10 mg PO q4–6h)
Pregnancy: not applicable
Pediatric: not applicable
References
1. Mahabir RC, Peterson BD, Williamson JS, et al. Locally administered ketorolac
and bupivacaine for control of postoperative pain in breast augmentation
patients. Plast Reconstr Surg. 2004;114(7):1910–1916.
2. Pavlin DJ, Chen C, Penaloza DA, et al. Pain as a factor complicating recovery
and discharge after ambulatory surgery. Anesth Analg. 2002;95(3):627–634,
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