A pilot study of a breast surgery Enhanced Recovery After Surgery (ERAS) protocol to eliminate narcotic prescription at discharge

Rojas, Kristin E.; Manasseh, Donna‐Marie; Flom, Peter L.; Agbroko, Solomon; Bilbro, Nicole; Andaz, Charusheela; Borgen, Patrick I.

doi:10.1007/s10549-018-4859-y

Cited by 61 publications

(19 citation statements)

References 11 publications

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“…Pain scores were evaluated at one day and one week postoperatively, and scores were reported on a 1-10 scale. They found no significant difference in pain scores for the ERAS vs. control group patients in surgeries including lumpectomy, sentinel lymph node biopsy, and axillary lymph node dissection at both postoperative Day 2 and Week 1 [3] .…”

Section: Enhanced Recovery After Surgerymentioning

confidence: 94%

“…Rojas et al [3] further implemented and reported outcomes on an ERAS protocol focused on breast surgery procedures with a goal of eliminating narcotic prescriptions after discharge. Their ERAS protocol used opioid-sparing techniques to eliminate narcotic prescriptions at discharge without sacrificing perioperative pain control.…”

Section: Enhanced Recovery After Surgerymentioning

confidence: 99%

“…Abuse of opioid pain medications is estimated to affect over 12 million Americans, and prescription opioids contribute to more overdose deaths than cocaine and heroin combined [1,2] . In 2016, 42,000 people died from opioid overdose in the United States with nearly 530 deaths reported every week [3,4] . Opioids are linked with many adverse health effects including increased risk of falls, fractures, respiratory distress, and bowel obstruction.…”

Section: Introductionmentioning

confidence: 99%

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Narcotics and breast surgery: a review of current literature

Hite¹,

Klauber-DeMore²,

Abbott³

2019

JUMD

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Opioid consumption in the United States is the highest of all nations, with 42,000 people dying from opioid overdose in 2016. Patients with breast cancer undergoing curative-intent surgery are particularly vulnerable to developing persistent opioid use. It is anticipated that postoperatively nearly all of these women will receive prescription pain medication and that 20%-50% of patients will go on to develop acute and chronic pain after breast cancer surgery. In this review, we aim to better understand opioid use and ongoing efforts to reduce opioid abuse in breast cancer surgery patients.

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Section: Enhanced Recovery After Surgerymentioning

confidence: 94%

Section: Enhanced Recovery After Surgerymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Narcotics and breast surgery: a review of current literature

Hite¹,

Klauber-DeMore²,

Abbott³

2019

JUMD

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“…Although not intended to prevent opioid dependence, ERAS protocols should help by minimizing the need for narcotics for postoperative pain control. 22 In summary, ERAS is an effective, evidence-based tool widely embraced by other surgical subspecialties and with the potential to reduce opioid requirements of breast surgery patients. I congratulate the ASBrS for addressing the opioid crisis, providing these recommendations, and encouraging the adoption of ERAS pathways.…”

mentioning

confidence: 99%

Underutilization of Enhanced Recovery After Surgery (ERAS) in Breast Surgery: An Opportunity to Reduce Opioid Usage

Cyr

2020

Ann Surg Oncol

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Over a 20-year period, opioid-related deaths in the United States have increased sixfold. 1 In 2017, therefore, the Department of Health and Human Services officially declared this rapid increase in drug-related mortality a public health emergency. During that year, according to the Centers for Disease Control (CDC), more than 70,200 people died from drug overdoses; roughly 47,700 of those deaths involved opioids. Therefore, more people now die of opioid abuse or misuse annually than die of breast cancer. 2 Although this trend is multifactorial, a sharp increase in the number of opioid prescriptions is considered an important-and addressable-cause. 3 Despite the opioid crisis being a government and public health priority, the CDC offers little guidance for managing acute postsurgical pain. Although there are CDC pain management guidelines, they are written for primary care providers and make recommendations only for the treatment of chronic pain. 4 It has, therefore, been up to individual institutions and professional societies to create protocols for controlling surgical pain while addressing the new mandate to prevent opioid dependence. In this issue, Rao et al. 5 report the current breast and axillary surgery analgesia practices of members of the American Society of Breast Surgeons (ASBrS), and present the Society's perioperative pain control consensus statement. Roughly 20% of the 3000 ASBrS members who were invited to take the electronic survey responded. They were queried for methods of pain control used (local anesthesia, blocks, nonsteroidal anti-inflammatory drugs

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“…A recent publication examining an ERAS pathway for patients undergoing breast-conservation surgery demonstrated successful elimination of postoperative narcotic prescriptions by employing the use of preoperative medications, including acetaminophen and gabapentin, local analgesia infiltration at surgery, and postoperative ibuprofen alternating with acetaminophen. 5 In addition, the importance of preoperative patient counseling to include the recommendation to utilize non-narcotic medications such as ibuprofen and acetaminophen first, and emphasizing that these medications alone may be enough to control postoperative pain, has been demonstrated to be critical in reducing the need for postoperative opioids after mastectomy. 6 A limitation of the present study is that data were not available to determine whether the subject group received less intravenous opioids not because they had adequate pain control with non-narcotic analgesics but because they were transitioned to oral opioids earlier than those in the control group.…”

mentioning

confidence: 99%