Prescription Opioid Use among Opioid-Naive Women Undergoing Immediate Breast Reconstruction

Marcusa, Daniel P.; Mann, Rachel; Cron, David C.; Fillinger, Brooklyn R.; Rzepecki, Alexandra K.; Kozlow, Jeffrey H.; Momoh, Adeyiza O.; Englesbe, Michael J.; Brummett, Chad M.; Waljee, Jennifer F.

doi:10.1097/prs.0000000000003832

Cited by 86 publications

(93 citation statements)

References 58 publications

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“…Given the excellent long‐term survival from breast cancer, such patients are at risk of chronic opioid abuse that is not necessarily related to cancer pain . Recent studies have suggested that exposing opioid naïve patients to postoperative opioids converts approximately 10% of cancer patients undergoing curative‐intent oncology operations into chronic opioid users . Thus, it is paramount that surgeons minimize patient exposure to opioids while optimizing evidence‐based postoperative analgesia…”

Section: Discussionmentioning

confidence: 99%

“…21,22 Recent studies have suggested that exposing opioid naïve patients to postoperative opioids converts approximately 10% of cancer patients undergoing curative-intent oncology operations into chronic opioid users. 23,24 Thus, it is paramount that surgeons minimize patient exposure to opioids while optimizing evidencebased postoperative analgesia. 25 Although this is the largest study demonstrating opioid prescription preferences of breast surgical oncologists, there are several potential study limitations.…”

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confidence: 99%

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Surgeon perception versus reality: Opioid use after breast cancer surgery

Park

Kyrish

Terrell

et al. 2019

Journal of Surgical Oncology

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Background Few guidelines exist for an opioid prescription after breast surgical oncology (BSO) procedures. We sought to characterize opioid prescribing and use patterns by surgery type. Methods Patients (n = 332) undergoing BSO procedure were surveyed one week postoperatively for opioid use. The surgeons were surveyed about pain management preferences surgery type. CPT codes were collected for 2017 to calculate the amount of opioids used by surgery type relative to surgeon preference. Results Mean oral morphine equivalent (OME) preferred prescription for surgeons who did not tailor prescriptions by surgery type (n = 7, group A) was 177, whereas for those who did tailor (n = 10, group B) varied from 137 to 257 OME. There was a significant difference in opioid use by surgery type: 32 OME for segmental mastectomy (SM) ± sentinel lymph node dissection (SLND), 63 for SM + axillary lymph node dissection (ALND), 76 for total mastectomy (TM) ± SLND, 115 for TM + ALND (P < 0.001). Considering the type of surgeries performed group A prescribers would have 229190 unused OME and group B would have 230826 in 1 year. Conclusion Wide variation in opioid use by BSO procedure type was noted with substantial unused OME regardless ofprescribing preference. Evidence‐based guidelines are needed to tailor analgesic prescriptions according to the need.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Surgeon perception versus reality: Opioid use after breast cancer surgery

Park

Kyrish

Terrell

et al. 2019

Journal of Surgical Oncology

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“…The need for an opioid prescription may extend beyond a few months after surgery in 10% of patients undergoing breast reconstructive surgery,4 and long-term use may ultimately lead to complications. The development of a chronic pain syndrome as a complication is not uncommon and can occur in 20%–60% of patients 5…”

Section: Introductionmentioning

confidence: 99%

Interfascial block at the serratus muscle plane versus conventional analgesia in breast surgery: a randomized controlled trial

Mazzinari

Rovira

Casasempere

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesIn the context of opioid-sparing perioperative management, there is still little evidence from randomized controlled trials regarding the effectiveness of interfascial thoracic blocks. This study hypothesizes that receiving a serratus plane block reduces opioid requirements, pain scores, and rescue medication needs.MethodsThis double-blind, randomized controlled study was conducted on 60 adult females undergoing oncologic breast surgery. After general anesthesia, patients were randomly allocated to either conventional analgesia (control group, n=30) or single-injection serratus block with L-bupivacaine 0.25% 30mL (study group, n=30). First 24-hour total morphine consumption (primary outcome), pain scores at 1, 3, 6, 12, and 24 hours, time-to-first opioid rescue analgesia, and adverse effects were recorded.ResultsMedian 24 hours’ opioid dose was greater in the control group (median difference 9 mg (95% CI 4 to 14.5 mg); p<0.001). Proportional odds model showed that the study group has a lower probability of receiving opioid drugs (OR=0.26 (95% CI 0.10 to 0.68); p<0.001), while mastectomies have a higher probability of receiving them (OR=4.11 (95% CI 1.25 to 13.58); p=0.002). Pain scores in the study group were significantly lower throughout the follow-up period (p<0.001). Control group subjects needed earlier morphine rescue and had a higher risk of rescue dose requirement (p=0.002).ConclusionsInterfascial serratus plane block reduces opioid requirements and is associated with better pain scores and lower and later rescue analgesia needs in the first 24 hours, compared with conventional intravenous analgesia, in breast surgery.Trial registration numberNCT02905149.

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“…The stark increase in opioid misuse has led to a growing body of research focusing on the prescribing of opioids for postoperative pain, with many finding that most of the opioids prescribed postoperatively go unused . Therefore, understanding opioid needs and prescribing patterns after specific operations is essential .…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies have determined that the majority of patients undergoing general surgery procedures would have their pain needs met with less than 15 opioid pills (equivalent to 5 mg of oxycodone), and between 10 and 15 pills for oncologic breast‐specific surgery . Furthermore, it has been shown that new persistent opioid use is common following breast surgery, with 10% of patients undergoing breast surgery with immediate breast reconstruction (IBR) requiring opioids beyond 3 months postoperatively . The opioid requirements across the breadth of breast cancer operations and patient factors are less well understood than for other general surgery procedures .…”

Section: Introductionmentioning

confidence: 99%

Pain and opioid prescriptions vary by procedure after breast surgery

Murphy

Thiels

Hanson

et al. 2019

Journal of Surgical Oncology

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Background: With the opioid epidemic in the United States, evaluating opioid prescribing patterns is essential. We evaluated opioids prescribed at discharge following breast surgery and their association with patient factors and pain scores. Methods:We retrospectively identified adult patients who underwent a mastectomy for cancer at Mayo Clinic sites from January 2010 to December 2016. Pain scores and prescription data were compared across operations and patient factors by univariate and multivariable analyses.Results: Of 4021 patients, 3782 (94.1%) received an opioid prescription. Median oral milligram morphine equivalents (MME) were similar across all site-specific procedure groups (medians ranging from 225 to 375) while pain scores ranged from 1 to 4.Patients undergoing bilateral mastectomy (BM) and immediate breast reconstruction (IBR) reported the greatest pain scores. Pain scores did not vary with age or diagnosis for patients undergoing unilateral mastectomy or BM with lymph node surgery and IBR procedures.On multivariable analysis, variables associated with a MME discharge prescription >Q 4 values included age, body mass index, site, year, inpatient status, and pain before discharge >3.Conclusion: Patient-reported pain following breast surgery varied by procedure, while MMEs prescribed remained similar. This suggests current opioid prescribing does not reflect intensity of pain and requires further research to optimize discharge opioid prescribing practices.

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Prescription Opioid Use among Opioid-Naive Women Undergoing Immediate Breast Reconstruction

Abstract: Risk, III.

Cited by 86 publications

References 58 publications

Surgeon perception versus reality: Opioid use after breast cancer surgery

Surgeon perception versus reality: Opioid use after breast cancer surgery

Interfascial block at the serratus muscle plane versus conventional analgesia in breast surgery: a randomized controlled trial

Pain and opioid prescriptions vary by procedure after breast surgery

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