Post-operative Nausea and Analgesia Following Total Mastectomy is Improved After Implementation of an Enhanced Recovery Protocol.

Abstract

BACKGROUND:

Enhanced Recovery Protocols (ERPs) provide a multimodal approach to perioperative care, with the aims of improving patient outcomes while decreasing perioperative antiemetic and narcotic requirements. With high rates of post-operative nausea or vomiting (PONV) following total mastectomy (TM), we hypothesized that our institutional designed ERP would reduce PONV while improving pain control and decrease opioid use.

METHODS:

An ERP was implemented at a single institution for patients undergoing TM with or without implant-based reconstruction. Patients from the first two months of implementation (ERP group, N = 72) were compared with a retrospective usual-care cohort from a three-month period before implementation (UC group, N = 83). Outcomes included PONV incidence, measured with antiemetic use; patient-reported pain scores; perioperative opioid consumption, measured by oral morphine equivalents (OME); and length of stay (LOS).

RESULTS:

The characteristics of the two groups were similar. PONV incidence and perioperative opioid consumption were lower in the ERP than the UC group (21% vs. 40%, p 0.011 and mean 44.1 OME vs. 104.3 OME, p < 0.001), respectively. These differences in opioid consumption were observed in the operating room and post-anesthesia care unit (PACU); opioid consumption on the floor was similar between the two groups. Patient-reported pain scores were lower in the ERP than the UC group (mean highest pain score 6.4 vs. 7.4, p 0.003). PACU and hospital LOS were similar between the two groups.

CONCLUSION:

ERP implementation was successful in decreasing PONV following TM with and without reconstruction, while simultaneously decreasing overall opioid consumption without compromising patient comfort.

• Authors: Kate H Dinh, Priscilla F McAuliffe, Michael Boisen, Stephen A Esper, Kathirvel Subramaniam, Jennifer G Steiman, Atilla Soran, Ronald R Johnson, Jennifer M Holder-Murray, Emilia J Diego
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 27 Issue 12 Pg. 4828-4834 (Nov 2020) ISSN: 1534-4681 [Electronic] United States
• PMID: 32748151 (Publication Type: Journal Article)

Chemical References

• Analgesics, Opioid

Topics

• Analgesia
• Analgesics, Opioid (therapeutic use)
• Breast Neoplasms (surgery)
• Humans
• Mastectomy (adverse effects)
• Pain
• Pain, Postoperative (drug therapy, etiology, prevention & control)
• Postoperative Nausea and Vomiting (epidemiology, etiology, prevention & control)
• Retrospective Studies