Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
Peter Flom Consulting, New York, NY, USA.
Breast Cancer Res Treat. 2018 Oct;171(3):621-626. doi: 10.1007/s10549-018-4859-y. Epub 2018 Jun 18.
The evolving conceptualization of the management of surgical pain was a major contributor to the supply of narcotics that led to the opioid crisis. We designed and implemented a breast surgery-specific Enhanced Recovery After Surgery (ERAS) protocol using opioid-sparing techniques to eliminate narcotic prescription at discharge without sacrificing perioperative pain control.
A pilot observational study included patients with and without cancer undergoing lumpectomy. The convenience sample consisted of an ERAS group and a control usual care (UC) group who underwent surgery during the same time period. Discharge narcotic prescriptions were compared after converting to oral morphine milligram equivalents (MME's). Postoperative day one and week one pain scores were also compared between the two groups.
Ninety ERAS and 67 UC patients were enrolled. Most lumpectomies were wire-localized, and half of the patients in each group had breast cancer. There were more obese patients in the ERAS group. UC lumpectomy patients were discharged with a median of 54.5 MMEs (range 0-120), while the ERAS lumpectomy patients were discharged with none (p < 0.001). Postoperative pain scores were not significantly different between groups, and there were few complications.
A breast surgery-specific ERAS protocol employing opioid-sparing techniques successfully eliminated postoperative narcotic prescription without sacrificing perioperative pain control or increasing postoperative complications. By promoting the adoption of similar protocols, surgeons can continue to improve patient outcomes while decreasing the quantity of narcotics available for diversion within our patients' communities.
手术疼痛管理概念的不断发展是导致阿片类药物供应过剩从而引发阿片类药物危机的主要原因之一。我们设计并实施了一种特定于乳房手术的增强型术后恢复（ERAS）方案，该方案采用了减少阿片类药物的技术，以消除出院时的麻醉性镇痛药处方，而不影响围手术期疼痛控制。
一项试点观察性研究纳入了接受和不接受癌症手术的乳房切除术患者。该便利样本包括 ERAS 组和常规护理（UC）对照组，他们在同一时期接受手术。将出院时的麻醉性镇痛药处方转换为口服吗啡毫克当量（MME）后进行比较。还比较了两组患者术后第 1 天和第 1 周的疼痛评分。
共纳入 90 例 ERAS 组和 67 例 UC 组患者。大多数乳房切除术采用金属丝定位，每组各有一半患者患有乳腺癌。ERAS 组中有更多的肥胖患者。UC 乳房切除术患者出院时平均开处 54.5 MME（范围 0-120），而 ERAS 乳房切除术患者则不开处（p < 0.001）。两组患者术后疼痛评分无显著差异，且并发症较少。
一种采用减少阿片类药物技术的特定于乳房手术的 ERAS 方案成功消除了术后麻醉性镇痛药处方，而不影响围手术期疼痛控制或增加术后并发症。通过推广类似的方案，外科医生可以在减少我们患者社区中可滥用的阿片类药物数量的同时，继续改善患者的预后。
