Pain Management in Breast Surgery: Recommendations of a Multidisciplinary Expert Panel—The American Society of Breast Surgeons

Brenin, David R.; Dietz, Jill R.; Baima, Jennifer; Cheng, Gloria; Froman, Joshua; Laronga, Christine; Ma, Ayemoethu; Manahan, Michele A.; Mariano, Edward R.; Rojas, Kristin E.; Schroen, Anneke T.; Tiouririne, Nassima Ait Daoud; Wiechmann, Lisa; Rao, Roshni

doi:10.1245/s10434-020-08892-x

Cited by 36 publications

(24 citation statements)

References 164 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…4 Liposomal bupivacaine is cost-prohibitive, and its superiority over traditional aqueous long-acting local anesthetics is not proven, 5 as recently discussed in the American Society of Breast Surgeons' multidisciplinary perioperative pain management guidelines. 6…”

Section: Presentmentioning

confidence: 99%

ASO Author Reflections: The Time to Incorporate Opioid-Minimizing Initiatives in Your Institution is now

2021

View full text Add to dashboard Cite

Section: Presentmentioning

confidence: 99%

ASO Author Reflections: The Time to Incorporate Opioid-Minimizing Initiatives in Your Institution is now

2021

View full text Add to dashboard Cite

“…The opioid epidemic has catalyzed collaboration between ASA and other professional societies and health care organizations to address many pain issues. 13,38,39 ASA is also a member organization of the National Academy of Medicine Action Collaborative on Countering the U.S. Opioid Epidemic, which is entering its third year and represents a unique public-private partnership addressing pain management guidelines, education for the health professions, and prevention, treatment, and recovery services. These relationships represent natural routes for the dissemination of best practices in evidence-based pain management.…”

Section: The Future Of Pain Medicinementioning

confidence: 99%

The Future of Pain Medicine

Rosenquist¹,

Mariano²

2021

ASA Monitor

Self Cite

View full text Add to dashboard Cite

OUR SPECIALTy BEyOND OPERATIVE ANESTHESIAManagement Best Practices Inter-Agency Task Force report, 8 and recognition of surgery as a risk factor for the development of chronic opioid use, 9 has caused the medical community to respond in recent years with opioid prescribing recommendations and safety initiatives [10][11][12] and an emphasis on multimodality as the pathway to better pain management. 13 The acceptance of pain as a potentially chronic condition defined at the level of the individual is also driving the field of pain medicine toward increased personalization. In addition, subspecialty areas in acute and transitional pain to complement the established field of chronic pain have emerged in recent years to fill existing gaps and provide comprehensive care. 14,15 In looking ahead, we wish to highlight three priority areas for improvement: prediction, coordination, and implementation.

show abstract

“…Recent recommendations from the American Society of Breast Surgeons reflect this paradigm shift, endorsing the use of postdischarge NSAIDs in lieu of routine opioids for pain control after breast surgery. 6 As opioid-sparing pain regimens are increasingly adopted, the risk of bleeding complications associated with NSAIDs has gained new relevance. A retrospective cohort study of patients undergoing lumpectomy from the American College of Surgeons National Surgical Quality Improvement Program demonstrated a 0.4% rate of reoperation for bleeding complications in the 30-day postoperative period (28/7167); however, perioperative NSAID exposure could not be assessed from this administrative database.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Postdischarge Nonsteroidal Anti-Inflammatory Drugs Are not Associated with Risk of Hematoma after Lumpectomy and Sentinel Lymph Node Biopsy with Multimodal Analgesia

et al. 2021

View full text Add to dashboard Cite

Background. Nonsteroidal anti-inflammatory drugs (NSAIDs) are increasingly used in ambulatory breast surgery. The risk of hematoma associated with intraoperative ketorolac is low, but whether concomitant routine discharge with NSAIDs increases the risk of hematoma is unclear. Methods. We retrospectively identified patients who underwent lumpectomy and sentinel lymph node biopsy (SLNB), and compared the 30-day risk of hematoma between patients discharged with opioids (opioid period: January 2018-August 2018) and patients discharged with NSAIDs with or without opioids (NSAID period: January 2019-April 2020). The association between study period and hematoma risk was assessed using multivariable models. Covariates included intraoperative ketorolac, home aspirin, and race/ethnicity. During the NSAID period, a survey was used to assess analgesic consumption on postoperative days 1-5. Results. In total, 2724 patients were identified: 858 (31%) in the opioid period and 1866 (69%) in the NSAID period. In the NSAID period, 867 (46%) received NSAIDs and opioids, and 999 (54%) received NSAIDs only. Receipt of intraoperative ketorolac was higher in the NSAID period (78 vs. 64%, P \ 0.001). The risks of any hematoma (4.1 vs. 3.6%, P = 0.6) and reoperation for bleeding (0.5 vs. 0.6%, P = 0.8) were similar between groups. Study period was not associated with hematoma risk (odds ratio 0.87, 95% confidence interval 0.56-1.35, P = 0.5). Among survey respondents (41%), nonopioid analgesic consumption did not increase after opioids were removed from the discharge regimen (median, 6 pills/group, P = 0.06). Conclusions. NSAIDs are associated with a low risk of hematoma after lumpectomy and SLNB, and should be prescribed instead of opioids, unless contraindicated.

show abstract

Pain Management in Breast Surgery: Recommendations of a Multidisciplinary Expert Panel—The American Society of Breast Surgeons

Cited by 36 publications

References 164 publications

ASO Author Reflections: The Time to Incorporate Opioid-Minimizing Initiatives in Your Institution is now

ASO Author Reflections: The Time to Incorporate Opioid-Minimizing Initiatives in Your Institution is now

The Future of Pain Medicine

Postdischarge Nonsteroidal Anti-Inflammatory Drugs Are not Associated with Risk of Hematoma after Lumpectomy and Sentinel Lymph Node Biopsy with Multimodal Analgesia

Contact Info

Product

Resources

About