Decreasing Opioid Prescriptions in Women Undergoing Mastectomy and Breast Reconstruction.

BACKGROUND

Florida enacted legislation limiting opioid prescriptions and affecting the management of acute pain in the postoperative patient. Patients in a reconstructive surgery practice were receiving prescriptions for opioids as their primary method of pain management. Clinic providers identified a need to limit opioid prescriptions.

AIM

The aim of this quality improvement initiative was to decrease the number of opioids prescribed while effectively managing pain in women undergoing mastectomy and breast tissue expander placement.

DESIGN

This is a quality improvement project.

METHODS

The Model for Improvement was used as a framework for this project. An evidence-based pain management plan was developed after a review of the breast reconstruction surgery literature. The plan incorporated preoperative patient and family education and the standard use of preemptive analgesia, intraoperative nerve blocks, and postoperative multimodal analgesia in all patients undergoing mastectomy with breast tissue expander placement. Patient and family education and perioperative pain management were provided to patients, and the number of opioid tablets prescribed was tracked.

RESULTS

Between January 2018 and August 2019, the average number of opioid tablets prescribed per patient decreased from 84.7 to 8.4.

CONCLUSIONS

Opioid prescriptions can be decreased in women undergoing breast reconstruction with the use of patient education and multimodal analgesia.