Opioid Consumption Following Breast Surgery Decreases with a Brief Educational Intervention: A Randomized, Controlled Trial

• Published in: Annals of surgical oncology Vol. 27; no. 9; pp. 3156 - 3162
• Main Authors: Egan, Katie G., De Souza, Michelle, Muenks, Elizabeth, Nazir, Niaman, Korentager, Richard
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-09-2020
• Subjects: Analgesics, Opioid - therapeutic use; Breast Implants; Breast Neoplasms - surgery; Female; Health Services Research and Global Oncology; Humans; Mammaplasty - adverse effects; Mammaplasty - methods; Mastectomy - adverse effects; Mastectomy - methods; Medicine; Medicine & Public Health; Oncology; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Pain, Postoperative - psychology; Patient Education as Topic; Practice Patterns, Physicians; Surgery; Surgical Oncology
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-020-08432-7

Background
Current rates of opioid prescribing and consumption in the United States have resulted in deleterious consequences for both patients and society. There has been a focus on opioid consumption and overprescribing, but the utility of patient education in reducing opioid consumption has only recently been explored. This randomized trial aimed to evaluate the effectiveness of a brief patient educational intervention in reducing pain and opioid consumption in patients undergoing mastectomy and breast reconstruction.
Methods
A parallel, randomized, single-center trial of women undergoing mastectomy with immediate, implant-based breast reconstruction was completed to evaluate the utility of a patient educational instrument with information on multi-modal pain control. A questionnaire was administered postoperatively to collect data on pain control and opioid consumption.
Results
Fifty participants were randomized to each group preoperatively; 46 control (92%) and 39 intervention (78%) participants completed the postoperative questionnaire. Active tobacco use was more common in the control group (
p
 = 0.04). There was a trend towards lower pain scores in the intervention group (3.0/10, SD 1.8 vs 3.6/10, SD 1.6,
p
 = 0.06). Both groups were prescribed a median of 32.0 5-mg oxycodone tablets postoperatively. Participants in the intervention group consumed 33% fewer opioids than the control group (16.2 tablets, SD 16.4 vs 24.3 tablets, SD 21.8,
p
 = 0.05).
Conclusions
The use of a brief educational intervention provided at a preoperative appointment can reduce opioid consumption. We recommend the use of an educational intervention to decrease opioid consumption among breast surgery patients.