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Opioid Consumption Following Breast Surgery Decreases with a Brief Educational Intervention: A Randomized, Controlled Trial

Abstract

Background

Current rates of opioid prescribing and consumption in the United States have resulted in deleterious consequences for both patients and society. There has been a focus on opioid consumption and overprescribing, but the utility of patient education in reducing opioid consumption has only recently been explored. This randomized trial aimed to evaluate the effectiveness of a brief patient educational intervention in reducing pain and opioid consumption in patients undergoing mastectomy and breast reconstruction.

Methods

A parallel, randomized, single-center trial of women undergoing mastectomy with immediate, implant-based breast reconstruction was completed to evaluate the utility of a patient educational instrument with information on multi-modal pain control. A questionnaire was administered postoperatively to collect data on pain control and opioid consumption.

Results

Fifty participants were randomized to each group preoperatively; 46 control (92%) and 39 intervention (78%) participants completed the postoperative questionnaire. Active tobacco use was more common in the control group (p = 0.04). There was a trend towards lower pain scores in the intervention group (3.0/10, SD 1.8 vs 3.6/10, SD 1.6, p = 0.06). Both groups were prescribed a median of 32.0 5-mg oxycodone tablets postoperatively. Participants in the intervention group consumed 33% fewer opioids than the control group (16.2 tablets, SD 16.4 vs 24.3 tablets, SD 21.8, p = 0.05).

Conclusions

The use of a brief educational intervention provided at a preoperative appointment can reduce opioid consumption. We recommend the use of an educational intervention to decrease opioid consumption among breast surgery patients.

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Acknowledgments

This project would not have been possible without the assistance of the University of Kansas Department of Plastic Surgery, especially the breast reconstructive surgeons: Drs. James Butterworth, David Chandler, Michelle De Souza, Charles Hendrix, Eric Lai, Richard Korentager, and Satish Ponnuru; and our exceptional nurses: Heather Barnhart, Mary Gianaris, Stephanie Mattingly, Jennifer Norris, Alisha Pritchard, and Lynn Waller, as well as Myra Selby, MA. The authors would like to extend their sincere gratitude to Andrea Allen, MD, for assistance with data collection, and to the University of Kansas Breast Surgical Oncologists: Drs. Amanda Amin, Christa Balanoff, Kelsey Larson, Joshua Mammen, and Jamie Wagner. Thank you to Jennifer Hascall, M.Ed., for assistance with editing.

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Correspondence to Richard Korentager MD.

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The authors have nothing to disclose. No funding was received for this study.

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Egan, K.G., De Souza, M., Muenks, E. et al. Opioid Consumption Following Breast Surgery Decreases with a Brief Educational Intervention: A Randomized, Controlled Trial. Ann Surg Oncol 27, 3156–3162 (2020). https://doi.org/10.1245/s10434-020-08432-7

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  • DOI: https://doi.org/10.1245/s10434-020-08432-7