- Pain control (analgesia) — Gabapentin is a nerve medication that reduces pain when taken the night before surgery. Some pathways recommend continuing this medication at home for several weeks as it may also help reduce chronic pain from mastectomy.
- Nausea prevention — Post-operative nausea is more common after breast surgery than after other surgeries. If you have a history of this, please let your surgeon know ahead of time. A scopolamine patch can be placed behind your ear either the night before or morning of the surgery. You will need a prescription for this if your surgeon wants you to apply it before you come to the hospital. Most insurance covers this medication.During surgery, you may be given dexamethasone (a steroid) and/or ondansetron (Zofran) to prevent nausea. If you still have nausea, you may be given ondansetron or another oral anti-nausea medication to take at home. Staying well hydrated also helps prevent nausea.
- Regional anesthesia — This is the use of a local anesthetic like lidocaine or bupivicaine to numb up the nerves responsible for sensation at the surgery site. This can be done with a block of the nerves before surgery or a long-acting local anesthetic injected at the time of surgery. If you’re having a mastectomy, you may be discharged with a pain pump that is placed in the mastectomy site and stays in for several days.
- Anti-inflammatory medicines — These medicines reduce pain by reducing the inflammation caused by surgery. When taken in combination with opioids, they are even more effective than when taken alone.
- Reducing surgical infections — Washing with an antibacterial soap before and after surgery may help reduce the risk of a wound infection. You will be thoroughly cleansed in the operating room before surgery begins. Washing hands before and after handling drains and dressings reduces infection. Controlling blood sugars, if diabetic, and quitting smoking before surgery also reduce the risk of infections. You will receive one dose of antibiotics before the surgery begins and your surgeon may prescribe antibiotics while the drain is in place.
- Activity after surgery — Getting out of bed the night after surgery is a very important part of ERAS. Patients who move early have less pain and recover faster. Many pathways give patients instruction in upper body exercises to be started right after surgery to improve range of motion and maintain strength. Although most surgeons recommend no lifting more than 10lbs for a few weeks, moving your arms and shoulders is important to prevent future stiffness and lymphedema.
As with any surgery, the recovery period will not be pain free. But this method of caring for you will give you the best pain control possible with better recovery and fewer complications. Knowing your plan of care and being an active participant will help you recover.