Roshni Rao1, Rubie Sue Jackson2, Barry Rosen3, David Brenin4, Wendy Cornett5, Oluwadamilola M Fayanju6, Steven L Chen7, Negar Golesorkhi8, Kandice Ludwig9, Ayemoethu Ma10, Starr Koslow Mautner11, Michelle Sowden12, Lee Wilke13, Barbara Wexelman14, Sarah Blair15, Monique Gary16, Stephen Grobmyer17, E Shelley Hwang6, Ted James18, Nimmi S Kapoor19, Jaime Lewis20, Ingrid Lizarraga21, Megan Miller22, Heather Neuman13, Shayna Showalter4, Linda Smith23, Joshua Froman24. 1. Columbia University Irving Medical Center, New York Presbyterian, New York, NY, USA. rr3181@cumc.columbia.edu. 2. Anne Arundel Medical Center, Annapolis, MD, USA. 3. The University of Ilinois College of Medicine, Chicago, IL, USA. 4. University of Virginia, Charlottesville, VA, USA. 5. Prisma Health, Greenville, SC, USA. 6. Duke University Medical Center, Durham, NC, USA. 7. Oasis MD, San Diego, CA, USA. 8. Maryland Surgeons, Catonsville, MD, USA. 9. Indiana University School of Medicine, Indianapolis, IN, USA. 10. Scripps Health, San Diego, CA, USA. 11. Miami Cancer Institute, Miami, FL, USA. 12. The University of Vermont, Burlington, VT, USA. 13. University of Wisconsin School of Medicine, Madison, WI, USA. 14. Trihealth Cancer Institute, Cincinnati, OH, USA. 15. University of California San Diego, San Diego, CA, USA. 16. Grand View Health, Sellersville, PA, USA. 17. Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. 18. Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA. 19. Cedars-Sinai Medical Center, Los Angeles, CA, USA. 20. University of Cincinnati, Cincinnati, OH, USA. 21. University of Iowa, Iowa City, IA, USA. 22. University Hospitals Cleveland Medical Center, Cleveland, OH, USA. 23. Comprehensive Breast Care, Albuquerque, NM, USA. 24. Mayo Clinic Health System, Owatonna, MN, USA.
Abstract
INTRODUCTION: The opioid epidemic in the United States is a public health crisis. Breast surgeons are obligated to provide good pain control for their patients after surgery but also must minimize administration of narcotics to prevent a surgical episode of care from becoming a patient's gateway into opioid dependence. METHODS: A survey to ascertain pain management practice patterns after breast surgery was performed. A review of currently available literature that was specific to breast surgery was performed to create recommendations regarding pain management strategies. RESULTS: A total of 609 surgeons completed the survey and demonstrated significant variations in pain management practices, specifically within regards to utilization of regional anesthesia (e.g., nerve blocks), and quantity of prescribed narcotics. There is excellent data to guide the use of local and regional anesthesia. There are, however, fewer studies to guide narcotic recommendations; thus, these recommendations were guided by prevailing practice patterns. CONCLUSIONS: Pain management practices after breast surgery have significant variation and represent an opportunity to improve patient safety and quality of care. Multimodality approaches in conjunction with standardized quantities of narcotics are recommended.
INTRODUCTION: The opioid epidemic in the United States is a public health crisis. Breast surgeons are obligated to provide good pain control for their patients after surgery but also must minimize administration of narcotics to prevent a surgical episode of care from becoming a patient's gateway into opioid dependence. METHODS: A survey to ascertain pain management practice patterns after breast surgery was performed. A review of currently available literature that was specific to breast surgery was performed to create recommendations regarding pain management strategies. RESULTS: A total of 609 surgeons completed the survey and demonstrated significant variations in pain management practices, specifically within regards to utilization of regional anesthesia (e.g., nerve blocks), and quantity of prescribed narcotics. There is excellent data to guide the use of local and regional anesthesia. There are, however, fewer studies to guide narcotic recommendations; thus, these recommendations were guided by prevailing practice patterns. CONCLUSIONS:Pain management practices after breast surgery have significant variation and represent an opportunity to improve patient safety and quality of care. Multimodality approaches in conjunction with standardized quantities of narcotics are recommended.
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