New approach reduces opioid painkiller use after breast reconstruction surgery

A new approach to breast reconstruction surgery aimed at helping patients' bodies get back to normal more quickly cut their postoperative opioid painkiller use in half and meant a day less in the hospital on average, a newly reported study found. The method includes new pain control techniques, preventive antinausea treatment, and getting women eating and walking soon after free-flap breast reconstruction surgery. The findings were presented at the Plastic Surgery Research Council annual meeting, in New York, New York.

The approached, developed by the Mayo Clinic, has proved so effective that it is now being used across plastic surgery at Mayo Clinic.

Breast reconstruction surgery is common after breast tissue is removed to prevent or treat breast cancer; in free-flap breast reconstruction, the plastic surgeon transfers a section of tissue from one part of the body to the chest. Using traditional care, the hospital stay averaged roughly 4.5 days after that procedure. Using a new approach known as an enhanced recovery pathway, patients spent an average of 3 days in the hospital, the researchers found.

Opioid painkiller use by patients in the hospital after surgery also declined with the new method, and those patients reported less pain at 24 hours after surgery than those who received the traditional approach. Calculated in oral morphine equivalents, opioid use averaged 142.3 mg over the first 3 days in the hospital, compared with an average of 321.3 mg over the same period with traditional care.

Patients are giving the changes positive reviews, said senior author Michel Saint-Cyr, MD, a plastic surgeon in the Breast Diagnostic Clinic at Mayo Clinic in Rochester, Minnesota.

“I think it minimizes their apprehension and anxiety preoperatively and they go into surgery with a better mindset. The majority do not think it was as painful as they thought it would be after surgery,” said Saint-Cyr. “We're seeing pain scales ranging from 0 to 4 out of 10, compared to 6 to 8 out of 10 before the pathway. Patients are happier, and they're getting out of the hospital faster.”

The study included 48 patients: 17 received traditional care, while 31 experienced the new approach.

Saint-Cyr, anesthesiologists, pharmacists, and nursing staff collaborated to develop the enhanced recovery pathway. It included preoperative analgesics to help prevent pain; nonsteroidal anti-inflammatories; use of the nerve-numbing agent liposomal bupivacaine in the surgical site during surgery; avoidance of postoperative opioids; administration of preventive nausea treatment; resumption of food and walking soon after surgery; and avoidance of the intensive care unit for routine monitoring.

In addition to leaving the hospital earlier, many patients are able to resume driving and working more quickly than with the traditional care method, Saint-Cyr explained. Many go home with the non-narcotic drug acetaminophen as their only painkiller, he stated.

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