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Reassessing Opioid Use in Breast Surgery.

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Summary

This study evaluated multimodal pain management after breast surgery, finding significant variation in opioid prescribing. Enhanced recovery protocols may help standardize care and reduce overprescription.

Keywords:
Breast surgeryEnhanced recovery after surgeryMultimodal pain regimenNarcoticOpioid epidemicOpioid prescription guidelines

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Area of Science:

  • Pain Management
  • Surgical Oncology
  • Pharmacology

Background:

  • Assessing multimodal pain management and opioid prescribing practices in breast surgery patients.
  • Focus on opioid-sparing regimens and adherence to guidelines.

Purpose of the Study:

  • Evaluate current multimodal pain management strategies in breast surgery.
  • Analyze opioid prescribing patterns and concordance with the Opioid Prescribing Engagement Network (OPEN).

Main Methods:

  • Retrospective review of 518 breast surgery patients (April 2018-September 2019).
  • Exclusion of patients with prior opioid use or contraindications to NSAIDs/APAP.
  • Assessment of opioid-sparing regimens and discharge opioid prescriptions (OMEs).

Main Results:

  • Prescribing concordance with OPEN varied (10-40% for minor procedures, 63-88% for mastectomy without reconstruction).
  • Discharge opioids for mastectomy with reconstruction averaged 134.4 OMEs, with 25% receiving refills.
  • Significant use of multimodal analgesics (APAP, NSAIDs, gabapentin, pregabalin, local anesthetics) perioperatively and intraoperatively.

Conclusions:

  • Multidisciplinary approach and enhanced recovery after surgery (ERAS) protocols are needed.
  • Standardization of perioperative regimens can mitigate opioid overprescription.
  • Need for improved adherence to opioid prescribing guidelines.