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Post-operative Nausea and Analgesia Following Total Mastectomy is Improved After Implementation of an Enhanced Recovery Protocol.
- Source :
-
Annals of surgical oncology [Ann Surg Oncol] 2020 Nov; Vol. 27 (12), pp. 4828-4834. Date of Electronic Publication: 2020 Aug 03. - Publication Year :
- 2020
-
Abstract
- Background: Enhanced Recovery Protocols (ERPs) provide a multimodal approach to perioperative care, with the aims of improving patient outcomes while decreasing perioperative antiemetic and narcotic requirements. With high rates of post-operative nausea or vomiting (PONV) following total mastectomy (TM), we hypothesized that our institutional designed ERP would reduce PONV while improving pain control and decrease opioid use.<br />Methods: An ERP was implemented at a single institution for patients undergoing TM with or without implant-based reconstruction. Patients from the first two months of implementation (ERP group, N = 72) were compared with a retrospective usual-care cohort from a three-month period before implementation (UC group, N = 83). Outcomes included PONV incidence, measured with antiemetic use; patient-reported pain scores; perioperative opioid consumption, measured by oral morphine equivalents (OME); and length of stay (LOS).<br />Results: The characteristics of the two groups were similar. PONV incidence and perioperative opioid consumption were lower in the ERP than the UC group (21% vs. 40%, p 0.011 and mean 44.1 OME vs. 104.3 OME, p < 0.001), respectively. These differences in opioid consumption were observed in the operating room and post-anesthesia care unit (PACU); opioid consumption on the floor was similar between the two groups. Patient-reported pain scores were lower in the ERP than the UC group (mean highest pain score 6.4 vs. 7.4, p 0.003). PACU and hospital LOS were similar between the two groups.<br />Conclusion: ERP implementation was successful in decreasing PONV following TM with and without reconstruction, while simultaneously decreasing overall opioid consumption without compromising patient comfort.
- Subjects :
- Analgesics, Opioid therapeutic use
Humans
Mastectomy adverse effects
Pain
Pain, Postoperative drug therapy
Pain, Postoperative etiology
Pain, Postoperative prevention & control
Postoperative Nausea and Vomiting epidemiology
Postoperative Nausea and Vomiting etiology
Postoperative Nausea and Vomiting prevention & control
Retrospective Studies
Analgesia
Breast Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1534-4681
- Volume :
- 27
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Annals of surgical oncology
- Publication Type :
- Academic Journal
- Accession number :
- 32748151
- Full Text :
- https://doi.org/10.1245/s10434-020-08880-1