key: cord-0790512-919l4ki2
authors: Morin, Claudya; Borgen, Patrick I.; Rojas, Kristin E.
title: ASO Author Reflections: The Time to Incorporate Opioid-Minimizing Initiatives in Your Institution is now
date: 2021-04-20
journal: Ann Surg Oncol
DOI: 10.1245/s10434-021-09966-0
sha: 2a3b07330731cfbb10b1ddf0c7a6024a3c6f11c1
doc_id: 790512
cord_uid: 919l4ki2

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The authors, building on prior work within their institution, 2 set out to determine whether post-lumpectomy pain control could be improved without opioids. Their analysis demonstrated that the rate of moderate-to-severe pain decreased from 34.3% to 19.1% (p \ 0.001) for lumpectomy patients who received the opioid-sparing protocol. 3 The perfect combination of multimodal elements remains to be determined. A recently published retrospective study found that intraoperative nonsteroidal anti-inflammatory drugs (NSAIDs) may not be appropriate for all mastectomy patients. 4 Liposomal bupivacaine is cost-prohibitive, and its superiority over traditional aqueous long-acting local anesthetics is not proven, 5 as recently discussed in the American Society of Breast Surgeons' multidisciplinary perioperative pain management guidelines. 6 

The specific elements of the ''perfect'' multimodal analgesia protocol continue to evolve while novel therapies are introduced and antiquated theories are abandoned. The basic tenets will remain the same. Preoperative education and expectation-setting to minimize anxiety, pre-emptive non-opioid medications or pain-blocking interventions, intraoperative anti-inflammatory medication, and postoperative multimodal analgesia without fluid overload or restrictive diets will facilitate an expeditious return to equilibrium. Because targeted oncologic therapies are becoming the standard of care, personalized multimodal protocols specific to surgical modality, comorbidities, disease processes, risk factors, and institutional resources will be the end result. This evolution could not come at a more critical time. The American Medical Association recently reported that opioid-related mortality has increased in the wake of the Coronavirus pandemic. 7 Furthermore, COVID-19 has shown us that the safest place for well patients is at home. This shared understanding coupled with multidisciplinary collaboration, the development of creative strategies for opioid minimization, and continuous assessment through quality metrics is the way forward.

Persistent controlled substance use following mastectomy with reconstruction surgery

A pilot study of a breast surgery Enhanced Recovery After Surgery (ERAS) protocol to eliminate narcotic prescription at discharge

Opioid-sparing multimodal analgesia protocol for lumpectomy patients results in improved postoperative pain control

Intraoperative ketorolac is associated with risk of reoperation after mastectomy: a single-center examination

Effect of wound infiltration with ropivacaine or bupivacaine analgesia in breast cancer surgery: a meta-analysis of randomized controlled trials

Pain management in breast surgery: recommendations of a multidisciplinary expert panel-The American Society of Breast Surgeons

Reports of increases in opioid-and other drug-related overdose and other concerns during COVID pandemic *Updated