Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct;28(11):5855-5864.
doi: 10.1245/s10434-021-09963-3. Epub 2021 Jun 2.

Opioid-Sparing Multimodal Analgesia Protocol for Lumpectomy Patients Results in Superior Postoperative Pain Control

Claudya Morin  1 , Yamini Patel  1 , Munazza Javid  1 , Sarah E Tevis  2 , Thais Fortes  3 , Peter Flom  4 , Charusheela Andaz  1 , Donna-Marie Manasseh  1 , Patrick Borgen  5 , Kristin E Rojas  6
Affiliations

Opioid-Sparing Multimodal Analgesia Protocol for Lumpectomy Patients Results in Superior Postoperative Pain Control

Claudya Morin et al. Ann Surg Oncol. 2021 Oct.

Abstract

Background: We sought to determine if lumpectomy patients who received perioperative opioid-sparing multimodal analgesia reported less pain when compared with those who received traditional opioid-based care.

Study design: A prospective cohort of patients undergoing lumpectomy who received an opioid-sparing multimodal analgesia protocol [no opioids group (NOP)] was compared with a large cohort of patients who received traditional care [opioids group (OG)]. In-hospital and discharge opioids were compared using oral morphine equivalents (OMEs). Postoperative day one and week one pain scores were compared using the Kruskal-Wallis test.

Results: Overall, 1153 patients underwent lumpectomy: 634 patients received the protocol (NOP), and 519 patients did not (OG). Median pain scores were significantly lower in the NOP cohort when compared with the OG cohort the day after surgery (2 vs. 0, p < 0.001) and the week after surgery (1 vs. 0, p < 0.001). NOP patients were significantly less likely to report severe pain (7-10 on a 10-point scale) the day after surgery compared with OG patients (15.7% vs. 6.9%, p = 0.004). Patients in the NOP cohort were discharged with a median of zero OMEs (range 0-150), while patients in the OG were discharged with a median of 90 OMEs (range 0-360; p < 0.001).

Conclusion: Implementation of an opioid-sparing multimodal analgesia protocol for lumpectomy patients resulted in superior pain control without a routine opioid prescription. Surgeons can improve their own patients' outcomes while addressing the larger societal issue of the opioid crisis by adopting similar protocols that decrease the quantity of opioids available for diversion.

PubMed Disclaimer

Conflict of interest statement

Patrick Borgen, Kristin E. Rojas and Donna-Marie Manasseh have received speaker’s honoraria from Pacira Pharmaceuticals, Inc. Claudya Morin, Yamini Patel, Munazza Javid, Sarah E. Tevis, Thais Fortes, Peter Flom, and Charusheela Andaz report no relevant commercial, financial, consultant, or institutional conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Preoperative, intraoperative, and postoperative elements of the opioid-sparing multimodal analgesia protocol for patients undergoing lumpectomy. APAP acetaminophen, GABA gabapentin, IV intravenous
Fig. 2.
Fig. 2.
Study cohort diagram
Fig. 3.
Fig. 3.
Subgroup analysis according to localization technique and axillary management. NS non-significant
See this image and copyright information in PMC

References

    1. American Cancer Society . Breast cancer facts and figures 2019–2020. Atlanta: American Cancer Society, Inc.; 2019.
    1. Hill MV, McMahon ML, Stucke RS, Barth RJ., Jr Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg. 2017;265(4):709–714. doi: 10.1097/SLA.0000000000001993. - DOI - PubMed
    1. Compton WM, Boyle M, Wargo E. Prescription opioid abuse: problems and responses. Prev Med. 2015;80:5–9. doi: 10.1016/j.ypmed.2015.04.003. - DOI - PubMed
    1. Caraceni A, Hanks G, Kaasa S, et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol. 2012;13:e58–e68. doi: 10.1016/S1470-2045(12)70040-2. - DOI - PubMed
    1. Vella-Brincat J, Macleod AD. Adverse effects of opioids on the central nervous systems of palliative care patients. J Pain Palliat Care Pharmacother. 2007;21(1):15–25. doi: 10.1080/J354v21n01_05. - DOI - PubMed

Substances

LinkOut - more resources