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Opioid Use following Outpatient Breast Surgery: Are Physicians Part of the Problem?

Hart, Alexandra M., M.D.; Broecker, Justine S., M.D.; Kao, Leslieann, M.D.; Losken, Albert, M.D.

Plastic and Reconstructive Surgery: September 2018 - Volume 142 - Issue 3 - p 611–620
doi: 10.1097/PRS.0000000000004636
Breast: Special Topic
Discussion
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Background: The increasing rate of opioid abuse warrants standardization of postoperative pain management. The purpose of this study was to analyze the use of opioids in pain control and patient satisfaction following ambulatory breast surgery.

Methods: This was a prospective study of a consecutive series of patients undergoing secondary breast reconstruction (n = 60) or breast reduction (n = 35). All patients were given a pain questionnaire preoperatively. Postoperatively, women received 30 tablets of oxycodone 5.0 mg/acetaminophen 325 mg. Patients were contacted three times: postoperative days 3 to 5, 8 to 10, and 30 or higher. All patients were queried on narcotic use, pain level (0 to 10), and satisfaction with pain control. Patients with allergies or taking narcotics preoperatively were excluded.

Results: Most in the secondary breast reconstruction group (61.5 percent) had stopped taking opioids by postoperative day 5. Patients consumed a mean of 11.4 tablets following secondary breast reconstruction and a mean of 17.5 tablets after breast reduction. A majority reported feeling satisfied with their pain management. At postoperative day greater than 30, most experienced very mild pain, with an improvement of 3.74 points following breast reduction. There were 18.6 and 12.5 tablets per patient left over for secondary breast reconstruction and breast reduction, respectively. A total of 1551 unused tablets were left over for the entire cohort at postoperative day greater than 30. There was no significant difference in average pain scores or interference with enjoyment or activity between those who did or did not take pain medication.

Conclusions: This commonly prescribed pain regimen provides adequate pain relief and satisfaction for breast surgery, with a substantial number of leftover tablets. Physicians as prescribers should be aware of discrepancies. Prescription of 30 opioid tablets after outpatient breast surgery appears unnecessary and excessive.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Atlanta, Ga.

From the Division of Plastic and Reconstructive Surgery, Emory University School of Medicine.

Received for publication September 27, 2017; accepted March 1, 2018.

Presented at the 60th Annual Meeting of the Southeastern Society of Plastic and Reconstructive Surgeons, in Sea Island, Georgia, June 11 through 15, 2017.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Albert Losken, M.D., 550 Peachtree Street NE, Suite 9000, Atlanta, Ga. 30308, alosken@emory.edu

©2018American Society of Plastic Surgeons