Surgeon perception versus reality: Opioid use after breast cancer surgery

Park, Ko Un; Kyrish, Kristin; Terrell, John A.; Yi, Min; Caudle, Abigail S.; Hunt, Kelly K.; Kuerer, Henry Mark; Bedrosian, Isabelle; Thompson, Alastair; DeSnyder, Sarah M.

doi:10.1002/jso.25395

Cited by 23 publications

(14 citation statements)

References 30 publications

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“…15 The current study adds to our understanding of pain management requirements in this population. There is substantial variation in opioid usage, particularly in breast surgery, 18 where recent work illustrates that opioid prescribing continues to outpace consumption 19 , and guidelines aimed at optimizing multimodal pain regimens are very much needed. 20 Furthermore, our consumption data suggest that prescription sizes may be further reduced without compromising patient satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Opioid prescribing exceeds consumption following common surgical oncology procedures

Eyrich

Sloss

Howard

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: Surgical oncology patients are vulnerable to persistent opioid use. As such, we aim to compare opioid prescribing to opioid consumption for common surgical oncology procedures. Methods: We prospectively identified patients undergoing common surgical oncology procedures at a single academic institution (August 2017-March 2018). Patients were contacted by telephone within 6 months of surgery and asked to report their opioid consumption and describe their discharge instructions and opioid handling practices. Results: Of the 439 patients who were approached via telephone, 270 completed at least one survey portion. The median quantity of opioid prescribed was significantly larger than consumed following breast biopsy (5 vs. 2 tablets of 5 mg oxycodone, p < .001), lumpectomy (10 vs. 2 tablets of 5 mg oxycodone, p < .001), and mastectomy or wide local excision (20 tablets vs. 2 tablets of 5 mg oxycodone, p < .001). The majority of patients reported receiving education on taking opioids, but only 27% received instructions on proper disposal; 82% of prescriptions filled resulted in unused opioids, and only 11% of these patients safely disposed of them. Conclusions: This study demonstrates that opioid prescribing exceeds consumption following common surgical oncology procedures, indicating the potential for reductions in prescribing.

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Section: Discussionmentioning

confidence: 99%

Opioid prescribing exceeds consumption following common surgical oncology procedures

Eyrich

Sloss

Howard

et al. 2020

Journal of Surgical Oncology

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“…To our knowledge, this is the first prospective randomized controlled study to reveal ropivacaine infiltration of the two drainage exit sites, which significantly reduced postoperative pain and analgesic requirements and improved the quality of recovery after mastectomy. Park's study [10] reported that compared with other breast surgical procedure types, mastectomy required consumption of more opioids during the first week postoperatively. Opioid consumption plays an important role in postoperative pain control after mastectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Park’s study [ 10 ] reported that compared with other breast surgical procedure types, mastectomy required consumption of more opioids during the first week postoperatively. Opioid consumption plays an important role in postoperative pain control after mastectomy.…”

Section: Discussionmentioning

confidence: 99%

Ropivacaine infiltration analgesia of the drainage exit site enhanced analgesic effects after breast Cancer surgery: a randomized controlled trial

et al. 2020

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Background Postoperative pain after breast cancer surgery remains a major challenge in patient care. Local infiltration analgesia is a standard analgesic technique used for pain relief after surgery. Its application in patients who underwent mastectomy requires more clear elucidation. This study aimed to investigate the effect of ropivacaine infiltration of drainage exit site in ameliorating the postoperative pain after mastectomy. Methods A prospective randomized controlled study was conducted in 74 patients who were scheduled for unilateral mastectomy by standardized general anesthesia. Both intervention group and control group were given infiltration of the two entry points of drainage catheters with 10 ml 0.5% ropivacaine (Group A) (n = 37) or 10 ml normal saline (Group B) (n = 37). Pain scores were recorded in post-anesthesia care unit (PACU), at 6 h, 12 h, 24 h and 36 h after operation by using a visual analogue scale (VAS). Postoperative nausea and vomiting (PONV) incidence, postoperative analgesic and antiemetic requirements, the incidence of chronic pain, as well as the quality of recovery were recorded. Results The patients in Group A showed a significant reduction in postoperative pain in PACU (p < 0.0005), at 6 h (p < 0.0005), 12 h (p < 0.0005), and 24 h after surgery (p < 0.05) when compared to those in Group B. There were more postoperative analgesic requirements in Group B (p < 0.05). With regard to the quality of recovery, Group A was shown to be much superior over Group B (p < 0.05). Conclusions Ropivacaine infiltration of the two drainage exit sites decreased the degree of postoperative acute pain after mastectomy, and this approach improved patients’ quality of recovery. Trial registration retrospectively registered in Chictr.org.cn registry system on 24 February 2020 (ChiCTR2000030139).

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“…При нарастании концентрации АФК Nrf2 диссоциирует от Keap1, перемещается в ядро и взаимодействует с антиоксидант-респонзивным элементом (ARE), отвечающим за экспрессию генов, таких как NAD(P)Hхиноноксидоредуктаза 1 (NQO1), гемоксигеназа 1 (HMOX1), глутаматцистеинлигаза (GCL), глутатион-S-трансферазы (GSTs), супероксиддисмутаза 2 (SOD2), глутатионпероксидаза 1 (GPX1), тиоредоксинредуктаза 1 (TRXR1) и каталаза [74][75][76][77], что необходимо для восстановления динамического редокс-гомеостаза в клетке (рис. 4) [11,70,[78][79][80].…”

Section: селенодефицит вызывает воспалениеunclassified

Selenium compounds in redox regulation of inflammation and apoptosis

et al. 2019

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Monocytes and macrophages play a key role in the development of inflammation: under the action of lipopolysaccharides (LPS), absorbed from the intestine, monocytes and macrophages form reactive oxygen species (ROS) and cytokines, this leads to the development of oxidative stress, inflammation and/or apoptosis in all types of tissues. In the cells LPS induce an “internal” TLR4-mediated MAP-kinase inflammatory signaling pathway and cytokines through the superfamily of tumor necrosis factor receptor (TNFR) and the “death domain” (DD) initiate an “external” caspase apoptosis cascade or necrosis activation that causes necroptosis. Many of the proteins involved in intracellular signaling cascades (MYD88, ASK1, IKKa/b, NF-kB, AP-1) are redox-sensitive and their activity is regulated by antioxidants thioredoxin, glutaredoxin, nitroredoxin, and glutathione. Oxidation of these signaling proteins induced by ROS enhances the development of inflammation and apoptosis, and their reduction with antioxidants, on the contrary, stabilizes the signaling cascades speed, preventing the vicious circle of oxidative stress, inflammation and apoptosis that follows it. Antioxidant (AO) enzymes thioredoxin reductase (TRXR), glutaredoxin reductase (GLRXR), glutathione reductase (GR) are required for reduction of non-enzymatic antioxidants (thioredoxin, glutaredoxin, nitroredoxin, glutathione), and AO enzymes (SOD, catalase, GPX) are required for ROS deactivation. The key AO enzymes (TRXR and GPX) are selenium-dependent; therefore selenium deficiency leads to a decrease in the body's antioxidant defense, the development of oxidative stress, inflammation, and/or apoptosis in various cell types. Nrf2-Keap1 signaling pathway activated by selenium deficiency and/or oxidative stress is necessary to restore redox homeostasis in the cell. In addition, expression of some genes is changed with selenium deficiency. Consequently, growth and proliferation of cells, their movement, development, death, and survival, as well as the interaction between cells, the redox regulation of intracellular signaling cascades of inflammation and apoptosis, depend on the selenium status of the body. Prophylactic administration of selenium-containing preparations (natural and synthetic (organic and inorganic)) is able to normalize the activity of AO enzymes and the general status of the body. Organic selenium compounds have a high bioavailability and, depending on their concentration, can act both as selenium donors to prevent selenium deficiency and as antitumor drugs due to their toxicity and participation in the regulation of signaling pathways of apoptosis. Known selenorganic compounds diphenyldiselenide and ethaselen share similarity with the Russian organo selenium compound, diacetophenonylselenide (DAPS-25), which serves as a source of bioavailable selenium, exhibits a wide range of biological activity, including antioxidant activity, that governs cell redox balance, inflammation and apoptosis regulation.

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Surgeon perception versus reality: Opioid use after breast cancer surgery

Cited by 23 publications

References 30 publications

Opioid prescribing exceeds consumption following common surgical oncology procedures

Opioid prescribing exceeds consumption following common surgical oncology procedures

Ropivacaine infiltration analgesia of the drainage exit site enhanced analgesic effects after breast Cancer surgery: a randomized controlled trial

Selenium compounds in redox regulation of inflammation and apoptosis

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