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Association between preoperative vitamin D level and postoperative pain in patients undergoing breast cancer surgery: a prospective observational study

Published on Tuesday, 10 November 2026

Abstract

Background: This study investigated the relationship between preoperative serum vitamin D levels and acute postoperative pain scores in patients undergoing unilateral breast cancer surgery.

Methods: The study was conducted at Fayoum University Hospital between September 2024 and April 2025. 184 American Society of Anesthesiologists (ASA) II-III female patients scheduled to undergo elective unilateral modified radical mastectomy were classified into two groups: 92 vitamin D-deficient (<30 nmol/L) and 92 vitamin D-sufficient (≥30 nmol/L). The primary outcome was the occurrence of moderate to severe postoperative pain (Numerical Rating Scale (NRS) >3) at 12 hours. A secondary 24-hour composite outcome (NRS >3 at any time within the first 24 hours) was used for the multivariable logistic regression. Other secondary outcomes included: preoperative serum 25(OH)D level, postoperative NRS, intraoperative fentanyl consumption, postoperative tramadol consumption, sedation scores, intraoperative and postoperative hemodynamics, patient satisfaction, and hospital stay.

Results: The baseline characteristics were well balanced between the groups, with small standardized mean differences for all variables. Patients with vitamin D deficiency had a higher occurrence of moderate to severe pain at 12 hours. In multivariable analysis, vitamin D deficiency was independently associated with moderate to severe postoperative pain at any time point during the first 24 hours (adjusted OR 3.12, 95% CI 1.58 to 6.13). Vitamin D-deficient patients had higher intraoperative fentanyl consumption (mean difference 8.04 µg, 95% CI 3.21 to 12.88) and postoperative tramadol consumption (mean difference 112.17 mg, 95% CI 101.44 to 122.91).

Conclusion: Vitamin D deficiency is associated with a higher occurrence of moderate to severe postoperative pain and increased opioid consumption in patients undergoing unilateral modified radical mastectomy.

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About this publication.

The Di Bella's Method: Use of Vitamin D, Melatonin (since 1974), Retinoids (40mg per day Beta-Carotene, 10mg per day ATRA and 10mg per day Axerophthol palmitate), Estrogen therapy (Anastrozole 1 mg tab per day), pseudo-Metronomic Chemotherapy Cyclophosphamide and/or Hydroxyurea, Somatostatin/Octreotide analogues and/or derivatives (since 1977) with prolactin inhibitors Cabergoline and/or Bromocriptine (together with others chemical compounds) in Breast Cancer (the dosage and administration schedule must be individualised for each patient):

- A retrospective observational clinical study of triple negative breast cancer cases treated with Di Bella Method: A preliminary data;

- The Synergism of Somatostatin, Melatonin, Vitamins Prolactin and Estrogen Inhibitors Increased Survival, Objective Response and Performance Status In 297 Cases of Breast Cancer;

- Complete objective response, stable for 5 years, with the Di Bella Method, of multiple-metastatic carcinoma of the breast;

- Evaluation of the safety and efficacy of the first-line treatment with somatostatin combined with melatonin, retinoids, vitamin D3, and low doses of cyclophosphamide in 20 cases of breast cancer: a preliminary report;

- The Di Bella Method (DBM) improved survival, objective response and performance status in a retrospective observational clinical study on 122 cases of breast cancer;

- Complete objective response to biological therapy of plurifocal breast carcinoma;

- The Di Bella Method (A Fixed Part - Dihydrotachysterol, Alfacalcidol, synthetic Vitamin D3 - Preferably the blood concentration value should be around the middle between 75ng/ml and 100ng/ml);

- Vitamin D (analogues and/or derivatives) and cancer - In vitro, review and in vivo publications;

- The Di Bella Method (A Fixed Part - Calcium, 2 grams per day, orally);

The Di Bella's Method: Use of Vitamin D analogues and/or derivatives - together with others chemical compounds: the dosage and administration schedule must be individualised for each patient - in several Oncological Pathologies:

- A retrospective observational study on cases of anaplastic brain tumors treated with the Di Bella Method: A rationale and effectiveness;

- Recurrent Glioblastoma Multiforme (grade IV – WHO 2007): a case of complete objective response achieved by means of the concomitant administration of Somatostatin and Octreotide – Retinoids – Vitamin E – Vitamin D3 – Vitamin C – Melatonin – D2 R agonists (Di Bella Method – DBM) associated with Temozolomide;

- The Di Bella Method DBM improved survival objective response and performance status in a retrospective observational clinical study on 23 tumours of the head and neck;

- Chronic Lymphocytic Leukemia: Long-Lasting Remission with Combination of Cyclophosphamide, Somatostatin, Bromocriptine, Retinoids, Melatonin, and ACTH;

- Somatostatin, retinoids, melatonin, vitamin D, bromocriptine, and cyclophosphamide in advanced non-small-cell lung cancer patients with low performance status;

- Somatostatin, retinoids, melatonin, vitamin D, bromocriptine, and cyclophosphamide in chemotherapy-pretreated patients with advanced lung adenocarcinoma and low performance status;

- Observations on the Report of a case of pulmonary adenocarcinoma with lymph node, hepatic and osseus metastasis;

- Pleural Mesothelioma: clinical records on 11 patients treated with Di Bella's Method;

- Malignant pleural mesothelioma, stage T3-T4. Consideration of a case study;

- Excellent result in a Mesothelioma case treated exclusively with Di Bella Method for over 4 years and still treatment with positive results;

- A case of advanced Multiple Myeloma treated with Di Bella Method (DBM) into total remission for 13 years;

- Neuroblastoma: Complete objective response to biological treatment;