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Reducing Narcotic Prescriptions in Breast Surgery: A Prospective Analysis

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

No clear standards regarding number or type of narcotics for adequate postoperative pain control have been established in breast surgery. The authors of this study reviewed their opioid-prescribing patterns and implemented a planned change, evaluated the effectiveness of a departmental practice adjustment, and prospectively evaluated patient narcotic usage.

Methods

The narcotic prescriptions for 100 consecutive breast surgery patients were reviewed to establish baseline postoperative narcotic-prescribing patterns. The median of narcotics prescribed was used to educate surgeons and implement a planned change in prescribing practices. Data on narcotic prescriptions for 100 consecutive breast surgery patients then were prospectively collected, and the number of pain pills the patients actually took after discharge was recorded using a standardized template.

Results

A baseline review of narcotic-prescribing practices showed that the median number of pills given was 15 for excisional biopsy/lumpectomy, 20 for mastectomy, and 28 for mastectomy with reconstruction. After departmental education, the median number decreased to 10 for excisional biopsy/lumpectomy (p < 0.01) and 25 for mastectomy with reconstruction (p < 0.01). Prospective recording of patient usage compared with the prescribed number of pills indicated that most prescribed pills were not used, with the excisional biopsy or lumpectomy patients using a median of 1 pill (p < 0.01), the mastectomy patients using a median of 3 pills (p < 0.01), and the mastectomy with reconstruction patients using a median of 18 pills (p < 0.01) postoperatively. Only three patients, all of whom had breast reconstruction performed, required a refill of narcotics.

Conclusions

Successful reduction in narcotic prescriptions can be implemented for breast surgery patients. Further reductions in narcotic prescriptions may be feasible based on prospective collected patient usage.

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References

  1. Madras BK. The surge of opioid use, addiction, and overdoses. JAMA Psychiatry. 2017. https://doi.org/10.1001/jamapsychiatry.2017.0163.

    Article  PubMed  Google Scholar 

  2. Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, 1999–2016. NCHS Data Brief. 2017;(294):1–8.

  3. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose deaths–United States, 2013–2017. MMWR Morb Mortal Wkly Rep. 2018;67:2013–7. https://doi.org/10.15585/mmwr.mm6751521e1.

    Article  Google Scholar 

  4. Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths–United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016. https://doi.org/10.15585/mmwr.mm655051e1.

    Article  PubMed  Google Scholar 

  5. Hart AM, Broecker J, Kao L, Losken A. Opioid usage following outpatient breast surgery. Plast Reconstr Surg. 2018. https://doi.org/10.1097/prs.0000000000004636.

    Article  PubMed  Google Scholar 

  6. Hill MV, Mcmahon ML, Stucke RS, Barth RJ. Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg. 2017;265:709–14. https://doi.org/10.1097/sla.0000000000001993.

    Article  PubMed  Google Scholar 

  7. Kumar K, Gulotta LV, Dines JS, et al. Unused opioid pills after outpatient shoulder surgeries given current perioperative prescribing habits. Am J Sports Med. 2017. https://doi.org/10.1177/0363546517693665.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tan WH, Yu J, Feaman S, et al. Opioid medication use in the surgical patient: an assessment of prescribing patterns and use. J Am Coll Surg. 2018. https://doi.org/10.1016/j.jamcollsurg.2018.04.032.

    Article  PubMed  Google Scholar 

  9. Bates C, Laciak R, Southwick A, Bishoff J. Overprescription of postoperative narcotics: a look at postoperative pain medication delivery, consumption, and disposal in urological practice. J Urol. 2011;185:551–5. https://doi.org/10.1016/j.juro.2010.09.088.

    Article  PubMed  Google Scholar 

  10. Shei A, Rice JB, Kirson NY, et al. Sources of prescription opioids among diagnosed opioid abusers. Curr Med Res Opin. 2015. https://doi.org/10.1185/03007995.2015.1016607.

    Article  PubMed  Google Scholar 

  11. Lewis ET, Cucciare MA, Trafton JA. What do patients do with unused opioid medications? Clin J Pain. 2014. https://doi.org/10.1097/01.ajp.0000435447.96642.f4.

    Article  PubMed  Google Scholar 

  12. Jones CM, Paulozzi LJ, Mack KA. Sources of prescription opioid pain relievers by frequency of past-year nonmedical use: United States, 2008–2011. JAMA Intern Med. 2014. https://doi.org/10.1001/jamainternmed.2013.12809.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Park KU, Kyrish K, Terrell J, et al. Surgeon perception versus reality: opioid use after breast cancer surgery. J Surg Oncol. 2019;119:909–15. https://doi.org/10.1002/jso.25395.

    Article  PubMed  Google Scholar 

  14. Fujii MH, Hodges AC, Russell RL, et al. Post-discharge opioid prescribing and use after common surgical procedure. J Am Coll Surg. 2018;226:1004–12. https://doi.org/10.1016/j.jamcollsurg.2018.01.058.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hill MV, Stucke RS, Billmeier SE, Kelly JL, Barth RJ. Guideline for discharge opioid prescriptions after inpatient general surgical procedures. J Am Coll Surg. 2018;226:996–1003. https://doi.org/10.1016/j.jamcollsurg.2017.10.012.

    Article  PubMed  Google Scholar 

  16. Overton HN, Hanna MN, Bruhn WE, et al. Opioid-prescribing guidelines for common surgical procedures: an expert panel consensus. J Am Coll Surg. 2018;227:411–8. https://doi.org/10.1016/j.jamcollsurg.2018.07.659.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Michigan-OPEN. 2019. New opioid-prescribing recommendations for 2019. Retrieved 20 April 2019 at http://michigan-open.org/new-opioid-prescribing-recommendations-for-2019/.

  18. Barker JC, DiBartola K, Wee C, et al. Preoperative multimodal analgesia decreases post-anesthesia care unit narcotic use and pain scores in outpatient breast surgery. Plast Reconstr Surg. 2018. https://doi.org/10.1097/prs.0000000000004804.

    Article  PubMed  Google Scholar 

  19. Batdorf NJ, Lemaine V, Lovely JK, et al. Enhanced recovery after surgery in microvascular breast reconstruction. J Plast Reconstr Aesthetic Surg. 2015. https://doi.org/10.1016/j.bjps.2014.11.014.

    Article  Google Scholar 

  20. Parsa FD, Cheng J, Stephan B, et al. Bilateral breast reduction without opioid analgesics: a comparative study. Aesthetic Surg J. 2017;37:892–9. https://doi.org/10.1093/asj/sjx038.

    Article  Google Scholar 

  21. Rojas KE, Manasseh DM, Flom PL, et al. A pilot study of a breast surgery Enhanced Recovery After Surgery (ERAS) protocol to eliminate narcotic prescription at discharge. Breast Cancer Res Treat. 2018. https://doi.org/10.1007/s10549-018-4859-y.

    Article  PubMed  Google Scholar 

  22. Campbell I, Cavanagh S, Creighton J, et al. To infiltrate or not? Acute effects of local anaesthetic in breast surgery. ANZ J Surg. 2015;85:353–7. https://doi.org/10.1111/ans.12541.

    Article  PubMed  Google Scholar 

  23. Byager N, Hansen MS, Mathiesen O, Dahl JB. The analgesic effect of wound infiltration with local anaesthetics after breast surgery: a qualitative systematic review. Acta Anaesthesiol Scand. 2014. https://doi.org/10.1111/aas.12287.

    Article  PubMed  Google Scholar 

  24. Zielinski J, Jaworski R, Smietanska I, Irga N, Wujtewicz M, Jaskiewicz J. A Randomized, double-blind, placebo-controlled trial of preemptive analgesia with bupivacaine in patients undergoing mastectomy for carcinoma of the breast. Med Sci Monit. 2011;17(10):CR589–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Gatherwright J, Knackstedt RW, Ghaznavi AM, et al. Prospective, randomized, controlled comparison of bupivacaine versus liposomal bupivacaine for pain management after unilateral delayed deep inferior epigastric perforator free flap reconstruction. Plast Reconstr Surg. 2018. https://doi.org/10.1097/prs.0000000000004360.

    Article  PubMed  Google Scholar 

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Correspondence to Stephen R. Grobmyer MD, FACS.

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Fan, B., Valente, S.A., Shilad, S. et al. Reducing Narcotic Prescriptions in Breast Surgery: A Prospective Analysis. Ann Surg Oncol 26, 3109–3114 (2019). https://doi.org/10.1245/s10434-019-07542-1

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  • DOI: https://doi.org/10.1245/s10434-019-07542-1

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