Reduction of postoperative opioid use in oncologic breast surgery and the creation of multimodal pain management guidelines and practices

Donna M. Bridge, Blake A. Bridge


Background: The US is in the midst of an opioid crisis. Prescribing physicians are now pressured to balance patient pain management and opioid prescribing behavior. The responsibility of curbing the flow of opioids into the general US populace and optimizing pain management for their patients is in the hands of the prescribing physician.
Methods: A two year study of postoperative pain management for oncologic breast surgery patients was conducted between 2016 and 2018. Of such, the majority of patients received operatively administered liposomal bupivacaine, a nonopioid long lasting bupivacaine, to aid postoperative recovery. Data pertaining to opioid usage and pain were collected, tabulated, and analyzed.
Results: For more invasive surgical cases, including total mastectomy, postoperative opioid usage was significantly reduced while for less invasive cases, including surgical biopsy and partial mastectomy with sentinel lymph node (SLN), opioid usage was both reduced and eliminated in a large portion of patients.
Conclusions: It is time that we upgrade our operative and postoperative pain management strategies to reflect advancements in surgical techniques and patient treatment. As breast surgery becomes less invasive, relying on opioids to manage postoperative pain poses more risk to patients and society than reward. It is time that auxiliary modes of pain management, such as liposomal bupivacaine, and medically relevant guidelines inform oncologic opioid prescribing behavior.