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. 2022 Mar;29(3):1737-1745.
doi: 10.1245/s10434-021-10981-4. Epub 2021 Oct 25.

Association Between Local Anesthetic Dosing, Postoperative Opioid Requirement, and Pain Scores After Lumpectomy and Sentinel Lymph Node Biopsy with Multimodal Analgesia

Kate R Pawloski  1 , Varadan Sevilimedu  2 , Rebecca Twersky  3 , Audree B Tadros  1 , Laurie J Kirstein  1 , Hiram S Cody 3rd  1 , Monica Morrow  1 , Tracy-Ann Moo  4
Affiliations

Association Between Local Anesthetic Dosing, Postoperative Opioid Requirement, and Pain Scores After Lumpectomy and Sentinel Lymph Node Biopsy with Multimodal Analgesia

Kate R Pawloski et al. Ann Surg Oncol. 2022 Mar.

Abstract

Background: Multimodal analgesia (MMA) during breast surgery reduces postoperative pain and opioid requirements, but the relative contribution of local anesthetic dosing as a component of MMA is not well defined among patients undergoing lumpectomy and sentinel lymph node biopsy (SLNB).

Patients and methods: We identified consecutive patients who underwent lumpectomy and SLNB with MMA from 1/2019 to 4/2020. Univariable and multivariable linear and logistic regression were used to examine associations between local anesthetics, opioid requirements in the post-anesthesia care unit (PACU), and pain scores in the PACU and on postoperative day (POD) 1.

Results: In total, 1603 patients [median tumor size, 14 mm (interquartile range 8-20 mm)] were included. The median PACU opioid requirement was 0 morphine milligram equivalents (interquartile range 0-5). PACU maximum pain was none or mild in 58% of patients and moderate to severe in 42%; among 420 survey respondents, 56% reported no or mild pain and 44% reported moderate to severe pain on POD 1. On multivariable analysis that adjusted for routine components of MMA, increasing doses of 0.5% bupivacaine were associated with reduced PACU opioid requirements (β -0.04, 95% confidence interval -0.07 to -0.01, p = 0.011) and lower odds of moderate to severe pain (odds ratio 0.98, 95% confidence interval 0.97-0.99, p < 0.001). Local anesthetics were not associated with pain scores on POD 1.

Conclusions: Higher amounts of local anesthetics reduce acute postoperative pain and opioid requirement after lumpectomy and SLNB. Maximizing dosing within weight-based limits is a low-risk, cost-effective pain control strategy that can be used in diverse practice settings.

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Figures

Fig. 1.
Fig. 1.
Scatterplot of the relationship between 1% lidocaine dose (mL) and PACU opioid requirement (MME).
Fig. 2.
Fig. 2.
Scatterplot of the relationship between 0.5% bupivacaine dose (mL) and PACU opioid requirement (MME).
Fig. 3.
Fig. 3.
Maximum post-anesthesia care unit (PACU) pain scores by dose of (a) 1% lidocaine and (b) 0.5% bupivacaine.
See this image and copyright information in PMC

References

    1. Beverly A, Kaye AD, Ljungqvist O, Urman RD. Essential elements of multimodal analgesia in enhanced recovery after surgery (ERAS) guidelines. Anesthesiol Clin. 2017;35(2):e115–e143. - PubMed
    1. 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;171(3):621–626. - PubMed
    1. Egan KG, De Souza M, Muenks E, Nazir N, Korentager R. Opioid consumption following breast surgery decreases with a brief educational intervention: A randomized, controlled trial. Ann Surg Oncol. 2020;27(9):3156–3162. - PubMed
    1. Rao R, Jackson RS, Rosen B, et al. Pain control in breast surgery: Survey of current practice and recommendations for optimizing management-american society of breast surgeons opioid/pain control workgroup. Ann Surg Oncol. 2020;27(4):985–990. - PMC - PubMed
    1. Brenin DR, Dietz JR, Baima J, et al. Pain management in breast surgery: Recommendations of a multidisciplinary expert panel-the american society of breast surgeons. Ann Surg Oncol. 2020;27(12):4588–4602. - PubMed

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