Mastectomy is no longer an indication for postoperative opioid prescription at discharge

Abstract

Background: A 10-step protocol employing multimodal analgesia was implemented in patients undergoing mastectomy to decrease the quantity of opioids prescribed at discharge.

Methods: Patients who received the Enhanced Recovery After Surgery (ERAS) protocol were compared to a control group. Inpatient and discharge prescription of opioids were compared using oral morphine equivalents (OMEs), along with postoperative pain scores.

Results: Between 2017 and 2018, fifty-seven patients were eligible for inclusion: 20 patients received ERAS and 37 received usual care (UC). The ERAS group received a mean of 2.4 (0-13) inpatient OMEs and the UC group received 13.7 (0-80) (p = 0.002). The ERAS group received 2.0 (0-40) OMEs at discharge and the UC group received 59.8 (0-120) (p < 0.001). Postoperative pain scores were significantly lower in the patients who received the ERAS protocol.

Conclusions: Patients who received the ERAS protocol required less postoperative opioids and reported lower pain scores when compared to a control group.

Keywords: Axillary dissection; Enhanced recovery after surgery; Manuscript; Mastectomy; Opioid crisis; Pain; Sentinel lymph node biopsy.