Decreasing Opioids in Outpatient Breast Surgery with an Enhanced Recovery after Surgery Program and Preoperative...

Area of Science:

• Surgical Oncology
• Anesthesiology
• Pain Management

Background:

• Enhanced Recovery After Surgery (ERAS) programs are primarily documented in inpatient settings.
• The application of ERAS in outpatient settings, particularly for breast surgery, requires further investigation.

Purpose of the Study:

• To evaluate the impact of an ERAS protocol, incorporating preoperative education, on opioid prescribing patterns.
• To assess patient outcomes, including pain management and complication rates, following outpatient breast surgery under an ERAS protocol.

Main Methods:

• A retrospective review compared patients undergoing outpatient breast surgery before and after the implementation of an ERAS protocol.
• The ERAS protocol emphasized preoperative education, multimodal pain control, and intraoperative nerve blocks.
• Data collected included opioid consumption (Oral Morphine Equivalent - OME), length of stay, and complication rates.

Main Results:

• The ERAS group showed a 41.5% decrease in prescribed OME (126.4 vs. 216 OMEs) and reduced PACU OME consumption (16.6 vs. 23.3 OMEs) compared to the pre-ERAS group.
• Fewer patients in the ERAS group needed additional opioid prescriptions post-operatively.
• No significant differences in major or minor complications were observed between the two groups.

Conclusions:

• An ERAS protocol, utilizing a multimodal pain management strategy and preoperative education, is effective in reducing opioid use in outpatient breast surgery.
• This approach demonstrates the feasibility and benefits of ERAS in the ambulatory surgical environment for breast procedures.