Implications Of Instituting An Eras Pathway In Patients Receiving Chemotherapy In Microsurgical Breast Reconstruction
Ricardo Garza, Jr., B.S.1, Carolyn E. Boyle, MSN, CRNA1, Julie L. Cooper, B.S.1, Yash Kadakia, B.A.1, Sami Khan, MD2, Sumeet S. Teotia, MD1, Nicholas T. Haddock, MD1.
1UT Southwestern, Dallas, TX, USA, 2Stony Brook University, Stony Brook, NY, USA.
PURPOSE: Neuropathy is a common side effect of chemotherapeutic agents. Manifestations chemotherapy induced neuropathy can present in a myriad of fashions, ranging from numbness, tingling, and pain to motor weakness and autonomic dysfunction. Given the nature of breast reconstruction, a significant portion of the patients have a history chemotherapy exposure; its effect on postoperative pain management has not been previously explored.
METHODS: The study is a retrospective review of patients who underwent DIEP flap breast reconstruction by the 2 senior authors from January 2016 to September 2019. The patients were separated into two groups, Pre-ERAS (Enhanced Recovery After Surgery), and ERAS. The primary outcome observed was postoperative opioid consumption, measured as Oral Morphine Equivalents (OME). P-values were obtained through univariate linear regression.
RESULTS: In total, 256 patients were analyzed, out of which 113 had chemotherapy exposure. The difference between opioid consumption in patients in the Pre-ERAS group without and with chemotherapy exposure was statistically significant (211.5mg vs 278.5mg, p=0.0279). There was no difference between opioid consumption with concern to chemotherapy history in the ERAS group (137.4mg vs 133.0mg, p=0.7251).
CONCLUSION: Patients with chemotherapy exposure required more opioids to be comfortable. It is unknown if this difference is secondary to increased pain or less effectiveness of opioids. More research is necessary to assess if there are better ways to address pain postoperatively on patients with chemotherapy exposure.
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