Postoperative Pain And Opioid Use After Breast Reduction With Or Without Preoperative Nerve Block
Samantha N. LaFontaine, BA, Amy Yao, MD, Lawrence Draper, MD, Teresa Benacquista, MD, Evan S. Garfein, MD, Katie E. Weichman, MD.
Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
Physician-prescribed opioids have been implicated as a contributing factor in the current opioid epidemic in the United States. Breast reduction mammoplasty is one of the most commonly performed plastic surgeries, and one for which patients are often sent home with a significant number of opioid painkillers. Through this prospective, observational study, we sought to better understand if pre-operative nerve blocks influence post-operative pain and opioid consumption after breast reduction.
Following IRB approval, patients scheduled to undergo breast reduction mammoplasty at a Montefiore Medical Center were recruited between June 2019 and September 2019. Patients were sent home from surgery with oxycodone alone or with other analgesia including acetaminophen, ibuprofen, or both. Patient-reported Likert pain scores and opioid consumption were collected by calling patients each day for the first 5 days after surgery. Pain scores and opioid consumption were compared for patients who received a nerve block preoperatively and those who did not.
Forty-seven patients who underwent breast reduction were included in the analysis. Thirteen patients (27.7%) were given a nerve block. There was no significant difference in complication rate between the two groups. Response rates for each day 1-5 post-operatively were 72.3%, 66.0%, 55.3%, 70.2%, and 68.1%. On average patients were prescribed 113.5 morphine equivalents (± 37.2) and consumed 50.3 (± 43.3) morphine equivalents or 44.6% (± 35.3) by the end of the first week after surgery. For all patients, the amount of morphine equivalents prescribed was correlated with the morphine equivalents taken (p < 0.05). There was no statistically significant difference between patients with or without nerve block in morphine equivalents prescribed, morphine equivalents taken, or percent of morphine equivalents taken. Mean Likert pain rating on post-operative day 1 was 4.7 (± 2.2) and was not significantly different for patients with or without a nerve block. All patients had a significant reduction in pain between post-operative day 1 and post-operative day 2 (p < 0.05), but the magnitude of pain reduction was significantly greater for those who had received a nerve block than those who had not (2.3 and 0.8 points on the Likert scale respectively, p < 0.05). No correlation was found between morphine equivalents prescribed or taken and pain reduction from the day 1 baseline at any time point. Only on post-operative day 4 was there a statistically significant correlation between morphine equivalents taken and Likert pain score.
Our results show that patients on average are only consuming 44.6% (± 35.3) of the opioid pain medications that they are being prescribed, suggesting post-operative opioids may be over-prescribed for breast reduction recovery. In addition, increased opioid consumption did not correlate with reduction in pain scores from baseline at any time points. The larger reduction in pain scores by post-operative day 2 in the nerve block group suggests that nerve blocks may provide an early benefit to patients during recovery from breast reduction.
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