Room For Improvement: Intraoperative Opioid Use In Autologous Breast Reconstruction
Ashley Brown, MD1, Jacqueline Stoneburner, BS1, Raquel Minasian, MD1, Michael Newman, MD2, Lisa Jewell, MD2.
1Keck USC, Los Angeles, CA, USA, 2Torrance Memorial Medical Center, Torrance, CA, USA.
PURPOSE: High opioid use is associated with adverse post-surgical outcomes including nausea, constipation, and increased rates of readmission. As such, interest in opioid reduction strategies has increased. Studies suggest that high dose administration of intraoperative opioids is associated with increased pain scores postoperatively. Little is known, however, about the relationship between intraoperative administration and postoperative opioid use in patients undergoing autologous breast reconstruction. We sought to explore this relationship further and to study the impact of intraoperative use of non-opioid analgesics.
METHODS: A retrospective review was conducted of patients undergoing free autologous breast reconstruction. Demographic and surgical information were obtained. Perioperative opioids (Peri-O) administered by the anesthesiologist intraoperatively and/or in the postanesthesia care unit (PACU) and postoperative opioids (Post-O) prescribed by the surgical team were obtained and converted to oral morphine equivalents (OME). Information on use of non-opioid analgesics was also obtained.
RESULTS: Of the charts reviewed, 104 had complete information and were included in the analysis. Peri-O OME was significantly higher than total Post-O OME (85.11 + 47.55 versus 57.03 + 68.75, p = 0.001). Patients that received Tylenol and/or Toradol intraoperatively required significantly less Post-O OME than patients that did not receive Tylenol and/or Toradol intraoperatively (51.41 + 64.12 versus 96.36 + 88.43, p = 0.027).
CONCLUSION: Use of intraoperative non-opioid analgesics may be associated with decreased postoperative opioid use. Efforts to reduce opioid use should be expanded to include intraoperative/PACU opioid administration and will likely require a multidisciplinary approach between surgeon and anesthesiologist.
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