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