Updated Recommendations for the Management of Pain After Breast Surgery
Take home message:
Deaths related to opioid use continue to rise and most Americans have their initial encounter with opioids in the surgical setting. Pain control following breast surgery may be very successful with nerve blocks, nonsteroidal anti-inflammatory medications and local anesthesia. This population of patients may then avoid a risk of opioid addiction.
Rao, R., Jackson, R.S., Rosen, B. et al.
Pain Control in Breast Surgery: Survey of Current Practice and Recommendations for Optimizing Management—American Society of Breast Surgeons Opioid/Pain Control Workgroup.
Ann Surg Oncol (2020). https://doi.org/10.1245/s10434-020-08197-z
The opioid crisis remains a public health issue in the United States. As surgery provides the initial encounter for most Americans to opioid prescriptions, the American Society of Breast Surgeons (ASBrS) created a workgroup to evaluate opioids and pain management among breast surgery patients. The group evaluated the current literature and issued a survey to its approximately 3,000 members regarding their current clinical practices.
Based on its survey results, ASBrS reported that local anesthesia was the most common pain control approach by breast surgeons. Prior studies showed that local anesthesia consistently reduces pain in the immediate postoperative period and does not compromise the accuracy of the radiotracer for sentinel lymph node biopsy. Many regional anesthesia procedures, such as the pectoralis block, provide additional pain relief and decrease the amount of narcotic use. However, 43% of breast surgeons who responded to the survey reported they do not administer these regional blocks.
The ASBrS survey also showed that nonsteroidal anti-inflammatories (NSAIDs) were used in 96% of patients undergoing lumpectomy or excisional biopsy. Studies on the use of NSAIDs in breast surgery showed improvement in perioperative pain but should be avoided in those with a contraindication such as impaired kidney function. Many surgeons who completed the ASBrS survey reported recent changes to their breast pain management strategies, with 76% decreasing opioid use. Specific recommendations included reducing the acceptable number of pills prescribed for a given operation, with 10 pills or fewer recommended for lumpectomy patients.
The study identified an increased need for more widespread use of blocks for pain management in breast patients. For women who will be undergoing partial mastectomy also known as lumpectomy, it is of benefit to discuss your pain control plan prior to surgery.