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Wang H, Kwok WH, Yao LQ, Liu XL, Bressington D, Chen ML, Huang HQ, Wang T, Tan JYB. An evidence-based breathing exercise intervention for chronic pain management in breast cancer survivors: A phase II randomized controlled trial. Eur J Oncol Nurs 2024; 71:102625. [PMID: 38897104 DOI: 10.1016/j.ejon.2024.102625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/17/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Explore the preliminary effects of a breathing exercise (BE) intervention on chronic pain among breast cancer survivors. METHODS This two-parallel-arm, open-label pilot randomized controlled trial recruited 72 breast cancer survivors who were randomly allocated to either the control or intervention group (n = 36 each). Both groups received usual care and a pain information booklet, while the intervention group received 4 weeks of additional BE. The primary clinical outcome was measured using the Brief Pain Inventory (BPI), with secondary clinical outcomes measured by the Hospital Anxiety and Depression Scale (HADS), Quality of Life Patient/Cancer Survivor Version in Chinese (QOLCSV-C), and Functional Assessment of Cancer Therapy- Breast (FACT-B) immediately post-intervention and at 4-week follow-up. Both adjusted and unadjusted Generalized Estimating Equation models were utilized to assess the BE's potential effects, with safety assessed through participant self-report. RESULTS Sixty-eight participants completed the study. Statistical significance was observed in BPI in both adjusted and unadjusted models at post-intervention and follow-up (p < 0.05). BE demonstrated positive effects on anxiety, depression and quality of life improvement across all measures and timepoints in both adjusted and unadjusted models (p < 0.05). The effect sizes were smaller in the adjusted model. Three mild transient discomforts were reported associated with BE practice including dizziness, tiredness and yawning, without requirement of medical treatment. No severe adverse events occurred. CONCLUSION This BE intervention appears effective in alleviating chronic pain, anxiety and depression, and improving quality of life for breast cancer survivors. Fully powered large-scale studies are required to confirm its effects.
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Affiliation(s)
- Haiying Wang
- School of Nursing (Brisbane Centre), Faculty of Health, Charles Darwin University, Brisbane, QLD, Australia; School of Nursing and Midwifery & Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
| | - Wai Hang Kwok
- School of Nursing and Midwifery, Edith Cowan University, WA, Australia; School of Nursing, Faculty of Health, Charles Darwin University, Ellengowan Drive, Casuarina, NT, Australia
| | - Li-Qun Yao
- College of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou City, Fujian Province, China
| | - Xian-Liang Liu
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Homantin, Kowloon, Hong Kong SAR, China
| | - Daniel Bressington
- School of Nursing, Faculty of Health, Charles Darwin University, Ellengowan Drive, Casuarina, NT, Australia; Faculty of Nursing, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Meng-Ling Chen
- Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province, China
| | - Hou-Qiang Huang
- Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province, China
| | - Tao Wang
- School of Nursing (Brisbane Centre), Faculty of Health, Charles Darwin University, Brisbane, QLD, Australia.
| | - Jing-Yu Benjamin Tan
- School of Nursing and Midwifery & Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
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Alghamdi M, Alsayed B, Albenmousa F, Salleh SB, Alqaysi L, Alfayez J, Mandoorah J, Alanzi R, Alshayeqe G, Albaqmi S, Sabi A, Arif S, Mortada H. Local Anesthetic Infiltration for Pain Control in Aesthetic Breast Reduction Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Aesthetic Plast Surg 2024:10.1007/s00266-024-04249-x. [PMID: 38977458 DOI: 10.1007/s00266-024-04249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Aesthetic breast surgeries, including breast reduction, are commonly performed surgical procedures associated with postoperative pain. Pain control is essential to patient comfort, satisfaction, and early recovery. This systematic review is the first to conduct both qualitative and quantitative analysis to evaluate the efficacy and safety of local anesthetic infiltration in reducing pain after breast reduction surgeries. METHODS This systematic review is registered in PROSPERO, assessed for bias using the RoB2 tool, and follows the PRISMA guidelines. A full electronic search was performed in different databases for all clinical papers on adult female patients undergoing cosmetic breast reduction surgery who were given local anesthetic infiltration for postoperative pain relief. RESULTS A systematic review of five randomized clinical trials with a total of 191 patients found that local anesthetic infiltration significantly reduces postoperative pain in breast reduction surgery, reduces opioid consumption, and improves patient outcomes. A meta-analysis of two trials reported the mean VAS score for postoperative pain in the local anesthetic and placebo groups. CONCLUSION A systematic review and a meta-analysis show a significant reduction in postoperative pain following local anesthetic infiltration, but further research is needed to understand its effectiveness and potential adverse effects. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Maysaa Alghamdi
- College of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
| | - Bader Alsayed
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | | | - Sumayyah Bin Salleh
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Luba Alqaysi
- College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Joud Alfayez
- College of Pharmacy, Qassim University, Buraydah, Saudi Arabia
| | - Joana Mandoorah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Reem Alanzi
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ghina Alshayeqe
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sara Albaqmi
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ahmed Sabi
- College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Sultan Arif
- Department of Plastic Surgery and Burn Unit, Security Force Hospital, Riyadh, Saudi Arabia
| | - Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Plastic Surgery and Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
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3
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Mija D, Kehlet H, Joshi GP. Basic analgesic use in randomised trials assessing local and regional analgesic interventions for mastectomy: a critical appraisal and clinical implications. Br J Anaesth 2023; 131:921-924. [PMID: 37716888 DOI: 10.1016/j.bja.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/25/2023] [Accepted: 08/15/2023] [Indexed: 09/18/2023] Open
Abstract
Regional analgesia is a core component of an optimal multimodal analgesia technique. Several advanced regional analgesic techniques have been evaluated for mastectomy; however, the optimal choice remains unclear. Many randomised clinical trials (RCTs) evaluating various local/regional analgesic techniques do not include basic analgesics (i.e. paracetamol, non-steroidal anti-inflammatory drugs, cyclooxygenase-2 specific inhibitors, and dexamethasone) which precludes objective evaluation of their efficacy. The aim of this scoping review was to assess the use of basic analgesics in RCTs evaluating efficacy of local and regional analgesic techniques in patients undergoing mastectomy. PubMed was searched to identify relevant articles from January 1, 2010 to May 31, 2023. The key finding of this study is that almost 90% (n=82/92) of the RCTs evaluating local/regional analgesic techniques in patients undergoing mastectomy did not administer well accepted basic analgesics in the comparator groups. Consequently, the conclusions of the RCTs assessing local/regional analgesic techniques for mastectomy should be interpreted with caution. Also, clinical guidelines based on meta-analyses of these RCTs could be inadequate or inappropriate.
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Affiliation(s)
- Dan Mija
- Medical Graduate, Dallas, TX, USA
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Dickerson DM, Mariano ER, Szokol JW, Harned M, Clark RM, Mueller JT, Shilling AM, Udoji MA, Mukkamala SB, Doan L, Wyatt KEK, Schwalb JM, Elkassabany NM, Eloy JD, Beck SL, Wiechmann L, Chiao F, Halle SG, Krishnan DG, Cramer JD, Ali Sakr Esa W, Muse IO, Baratta J, Rosenquist R, Gulur P, Shah S, Kohan L, Robles J, Schwenk ES, Allen BFS, Yang S, Hadeed JG, Schwartz G, Englesbe MJ, Sprintz M, Urish KL, Walton A, Keith L, Buvanendran A. Multiorganizational consensus to define guiding principles for perioperative pain management in patients with chronic pain, preoperative opioid tolerance, or substance use disorder. Reg Anesth Pain Med 2023:rapm-2023-104435. [PMID: 37185214 DOI: 10.1136/rapm-2023-104435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
Significant knowledge gaps exist in the perioperative pain management of patients with a history of chronic pain, substance use disorder, and/or opioid tolerance as highlighted in the US Health and Human Services Pain Management Best Practices Inter-Agency Task Force 2019 report. The report emphasized the challenges of caring for these populations and the need for multidisciplinary care and a comprehensive approach. Such care requires stakeholder alignment across multiple specialties and care settings. With the intention of codifying this alignment into a reliable and efficient processes, a consortium of 15 professional healthcare societies was convened in a year-long modified Delphi consensus process and summit. This process produced seven guiding principles for the perioperative care of patients with chronic pain, substance use disorder, and/or preoperative opioid tolerance. These principles provide a framework and direction for future improvement in the optimization and care of 'complex' patients as they undergo surgical procedures.
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Affiliation(s)
- David M Dickerson
- Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Anesthesia & Critical Care, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Joseph W Szokol
- Department of Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Michael Harned
- Department of Anesthesiology, Division of Pain Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Randall M Clark
- American Society of Anesthesiologists, Park Ridge, Illinois, USA
| | - Jeffrey T Mueller
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Ashley M Shilling
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Mercy A Udoji
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
- Atlanta VA Health Care System, Decatur, Georgia, USA
| | | | - Lisa Doan
- Department of Anesthesiology, PerioperativeCare and Pain Medicine, New York University School of Medicine, New York, New York, USA
| | - Karla E K Wyatt
- Department of Anesthesiology, Perioperativeand Pain Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Medical Group, Detroit, Michigan, USA
| | - Nabil M Elkassabany
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jean D Eloy
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Stacy L Beck
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Maternal Fetal Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Lisa Wiechmann
- Department of Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Franklin Chiao
- Department of Anesthesiology, Westchester Medical Center, Valhalla, New York, USA
| | - Steven G Halle
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deepak G Krishnan
- Department of Oral & Maxillofacial Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
- Department of Oral & Maxillofacial Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - John D Cramer
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA
| | - Wael Ali Sakr Esa
- Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, USA
| | - Iyabo O Muse
- Department of Anesthesiology, Montefiore Medical Center, Bronx, New York, USA
- Department of Anesthesiology, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Jaime Baratta
- Department of Anesthesiology and Perioperative Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | | | - Padma Gulur
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Shalini Shah
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, California, USA
| | - Lynn Kohan
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Jennifer Robles
- Department of Urology Division of Endourology and Stone Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Surgical Service, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Eric S Schwenk
- Department of Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian F S Allen
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen Yang
- Department of Surgery, Division of Thoracic Surgery, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | | | - Gary Schwartz
- AABP Integrative Pain Care, Melville, New York, USA
- Maimonides Medical Center, Brooklyn, New York, USA
| | | | - Michael Sprintz
- Sprintz Center for Pain and Recovery, Shenandoah, Texas, USA
| | - Kenneth L Urish
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ashley Walton
- American Society of Anesthesiologists, Washington, District of Columbia, USA
| | - Lauren Keith
- American Society of Anesthesiologists, Park Ridge, Illinois, USA
| | - Asokumar Buvanendran
- Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA
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Emiroglu S, Esen E, Yalcin N, Azizoglu FS, Zent N, Bozdogan A, Tukenmez M, Muslumanoglu M, Cetingok H, Cavdar I, Cabioglu N. Effect of Cold Therapy on Managing Postoperative Pain Following Breast Conserving Surgery. Pain Manag Nurs 2023:S1524-9042(23)00058-9. [PMID: 36973091 DOI: 10.1016/j.pmn.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/20/2023] [Accepted: 03/03/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Cold therapy is an important non-pharmacologic method used for pain relief. AIM In the present study, we aimed to evaluate the therapeutic effect of cold therapy on managing postoperative pain following breast-conserving surgery (BCS) and assess its effect on recovering quality. METHOD The study was planned and implemented as a randomized controlled clinical study. Sixty patients with breast cancer were included in this study. All patients underwent BCS at Istanbul Faculty of Medicine. There were 30 patients in both the cold therapy and control groups. In the cold therapy group, a cold pack was placed around the incision line for 15 minutes every hour from the first hour after the operation until the 24th hour. To all the patients in both groups, pain levels were measured by visual analog scale (VAS) at the postoperative 1st, 6th, 12th, and 24th hours, respectively, and the quality of recovery was evaluated by a Quality of Recovery-40 questionnaire at the postoperative 24th hour. RESULTS The patients' median age was 53 (range: 24-71). All patients were T1-2 clinically and had no lymph node metastasis. Interestingly, the mean of pain level in the cold therapy group was statistically significantly lower in the first 24 hours (1st, 6th, 12th, and 24th hours) of the postoperative period (p = .001). Notably, the cold therapy group had higher recovering quality than the control group. In the first 24 hours, only 4 (12.5%) patients in the cold therapy group received additional analgesics, whereas all patients (100%) in the control group received additional analgesics (p = .001). CONCLUSIONS Cold therapy is an easy and effective non-pharmacologic method for pain relief after BCS in patients with breast cancer. Cold therapy reduces the acute pain of the breast and contributes to the quality of recovery of those patients.
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Affiliation(s)
- Selman Emiroglu
- Breast Surgery Service, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Evin Esen
- Breast Surgery Service, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nesli Yalcin
- Breast Surgery Service, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatma Sena Azizoglu
- Breast Surgery Service, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nazlıcan Zent
- Breast Surgery Service, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Atilla Bozdogan
- Breast Surgery Service, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Tukenmez
- Department of Statistics, Istanbul Commerce University, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Breast Surgery Service, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Cetingok
- Department of Algology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ikbal Cavdar
- Faculty of Health Sciences, Department of Nursing, Atlas University, Istanbul, Turkey
| | - Neslihan Cabioglu
- Breast Surgery Service, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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La J, Alqaydi A, Wei X, Shellenberger J, Digby GC, Brogly SB, Merchant SJ. Variation in opioid filling after same-day breast surgery in Ontario, Canada: a population-based cohort study. CMAJ Open 2023; 11:E208-E218. [PMID: 36882209 PMCID: PMC10000904 DOI: 10.9778/cmajo.20220055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Postoperative pain management practices in breast surgery are variable, with recent evidence that approaches for minimizing or sparing opioids can be successfully implemented. We describe opioid filling and predictors of higher doses in patients undergoing same-day breast surgery in Ontario, Canada. METHODS In this retrospective population-based cohort study, we used linked administrative health data to identify patients aged 18 years or older who underwent same-day breast surgery from 2012 to 2020. We categorized procedure types by increasing invasiveness of surgery: partial, with or without axillary intervention (P ± axilla); total, with or without axillary intervention (T ± axilla); radical, with or without axillary intervention (R ± axilla); and bilateral. The primary outcome was filling an opioid prescription within 7 or fewer days after surgery. Secondary outcomes were total oral morphine equivalents (OMEs) filled (mg, median and interquartile range [IQR]) and filling more than 1 prescription within 7 or fewer days after surgery. We estimated associations (adjusted risk ratios [RRs] and 95% confidence intervals [CIs]) between study variables and outcomes in multivariable models. We used a random intercept for each unique prescriber to account for provider-level clustering. RESULTS Of the 84 369 patients who underwent same-day breast surgery, 72% (n = 60 620) filled an opioid prescription. Median OMEs filled increased with invasiveness (P ± axilla = 135 [IQR 90-180] mg; T ± axilla = 135 [IQR 100-200] mg; R ± axilla = 150 [IQR 113-225] mg, bilateral surgery = 150 [IQR 113-225] mg; p < 0.0001). Factors associated with filling more than 1 opioid prescription were age 30-59 years (v. age 18-29 yr), increased invasiveness (RR 1.98, 95% CI 1.70-2.30 bilateral v. P ± axilla), Charlson Comorbidity Index ≥ 2 versus 0-1 (RR 1.50, 95% CI 1.34-1.69) and malignancy (RR 1.39, 95% CI 1.26-1.53). INTERPRETATION Most patients undergoing same-day breast surgery fill an opioid prescription within 7 days. Efforts are needed to identify patient groups where opioids may be successfully minimized or eliminated.
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Affiliation(s)
- Julie La
- Division of General Surgery and Surgical Oncology (La, Alqaydi, Merchant), Queen's University; ICES Queen's (Wei, Shellenberger, Brogly); Departments of Medicine (Digby) and Surgery (Brogly, Merchant), Queen's University, Kingston, Ont
| | - Anood Alqaydi
- Division of General Surgery and Surgical Oncology (La, Alqaydi, Merchant), Queen's University; ICES Queen's (Wei, Shellenberger, Brogly); Departments of Medicine (Digby) and Surgery (Brogly, Merchant), Queen's University, Kingston, Ont
| | - Xuejiao Wei
- Division of General Surgery and Surgical Oncology (La, Alqaydi, Merchant), Queen's University; ICES Queen's (Wei, Shellenberger, Brogly); Departments of Medicine (Digby) and Surgery (Brogly, Merchant), Queen's University, Kingston, Ont
| | - Jonas Shellenberger
- Division of General Surgery and Surgical Oncology (La, Alqaydi, Merchant), Queen's University; ICES Queen's (Wei, Shellenberger, Brogly); Departments of Medicine (Digby) and Surgery (Brogly, Merchant), Queen's University, Kingston, Ont
| | - Geneviève C Digby
- Division of General Surgery and Surgical Oncology (La, Alqaydi, Merchant), Queen's University; ICES Queen's (Wei, Shellenberger, Brogly); Departments of Medicine (Digby) and Surgery (Brogly, Merchant), Queen's University, Kingston, Ont
| | - Susan B Brogly
- Division of General Surgery and Surgical Oncology (La, Alqaydi, Merchant), Queen's University; ICES Queen's (Wei, Shellenberger, Brogly); Departments of Medicine (Digby) and Surgery (Brogly, Merchant), Queen's University, Kingston, Ont
| | - Shaila J Merchant
- Division of General Surgery and Surgical Oncology (La, Alqaydi, Merchant), Queen's University; ICES Queen's (Wei, Shellenberger, Brogly); Departments of Medicine (Digby) and Surgery (Brogly, Merchant), Queen's University, Kingston, Ont.
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Diana K, Teh MS, Islam T, Lim WL, Beh ZY, Taib NAM. Benefits of PECS Block as Part of the Enhanced Recovery After Surgery (ERAS) Protocol for Breast Cancer Surgery in an Asian Institution: A Retrospective Cohort Study. World J Surg 2023; 47:564-572. [PMID: 36599951 DOI: 10.1007/s00268-022-06881-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Regional analgesia techniques have been increasingly used for post-operative pain management following mastectomy. We aim to evaluate analgesic benefits of pectoral nerve (PECS2) block incorporated as part of the enhanced recovery after surgery (ERAS) protocol in patients undergoing mastectomy in University Malaya Medical Centre, Malaysia. MATERIAL AND METHODS A single centre, cohort study evaluating 335 women who have undergone unilateral mastectomy between January 2017 and March 2020 in Malaysia. Regional anaesthesia were given pre-operatively via ultrasound guided pectoral and intercostal nerves block (PECSII). RESULTS Utilization of regional anaesthesia increased from 11% in 2017 to 43% in 2020. Types and duration of surgeries were comparable. Opiod consumption was 3 mg lower in those who had PECS2 block ((27 [24-30] mg), in comparison with those who received general anaesthesia only (30 [26-34] mg), p < 0.001, and length of stay was half a day shorter in the regional anaesthesia group and these were statistically significant. However, pain score (2 [1-3]; 2 [1-3], p=0.719) and post-operative nausea and vomiting (PONV) (32.6-32.5%, p = 0.996) were similar. CONCLUSION This study highlights the importance of PECS2 block as a component of ERAS protocol for mastectomy in an Asian hospital. This study also inferred that patients may be safely discharged within 24 h of surgery and therefore, same day surgery may be feasible in selected group of patients undergoing mastectomy and this could imply overall cost benefits.
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Affiliation(s)
- Kavinya Diana
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mei-Sze Teh
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
| | - Tania Islam
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Woon-Lai Lim
- Department of Anaestesiology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Zhi-Yuan Beh
- Department of Anaestesiology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Nur Aishah Mohd Taib
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Armstrong VL, Hammond JB, Jogerst KM, Kosiorek HE, Teven C, Cronin P, Ahmad S, Rebecca A, Casey W, Pockaj B. The Impact of Same-Day Discharge and Enhanced Recovery on Patient Quality of Life After Mastectomy with Implant Reconstruction. Ann Surg Oncol 2023; 30:2873-2880. [PMID: 36705818 PMCID: PMC9882739 DOI: 10.1245/s10434-022-13019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/01/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study aimed to evaluate how enhanced recovery (ER) protocols and same-day discharge (SDD) influences patients' postoperative quality of life (QOL). METHODS Patients who underwent mastectomy with implant-based breast reconstruction from 2008 to 2020 were identified in a prospective database. The study assessed QOL with BREAST-Q and Was It Worth It? (WIWI) questionnaires. Responses were compared between the ER and pre-ER groups and between the SDD and hospital stay (HS) groups using one-way analysis of variance (ANOVA) and chi-square tests. RESULTS The inclusion criteria were met by 568 patients, with a 43% response rate, and 217 patients were included for analysis. Chest physical well-being was lower for the ER cohort, but postoperative breast satisfaction was higher. Psychosocial status, sexual well-being, and satisfaction with information given did not differ significantly between the ER group and the pre-ER or SDD group. In the compared groups, QOL did not differ significantly. CONCLUSIONS Enhanced recovery with SDD after mastectomy using implant-based reconstruction did not have an adverse impact on patient postoperative QOL.
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Affiliation(s)
- Valerie L. Armstrong
- Department of General Surgery. Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, USA
| | - Jacob B. Hammond
- Department of General Surgery. Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, USA
| | - Kristen M. Jogerst
- Department of General Surgery. Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, USA
| | - Heidi E. Kosiorek
- Department of Quantitative Health Sciences, Mayo Clinic Arizona, Phoenix, USA
| | - Chad Teven
- Department of Surgery. Division of Plastic Surgery, Mayo Clinic Arizona, Phoenix, USA
| | - Patricia Cronin
- Department of General Surgery. Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, USA
| | - Sarwat Ahmad
- Department of General Surgery. Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, USA
| | - Alanna Rebecca
- Department of Surgery. Division of Plastic Surgery, Mayo Clinic Arizona, Phoenix, USA
| | - William Casey
- Department of Surgery. Division of Plastic Surgery, Mayo Clinic Arizona, Phoenix, USA
| | - Barbara Pockaj
- Department of General Surgery. Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, USA
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Chan KY, Keogh S, Aucharaz N, Merrigan A, Tormey S. Opioid prescribing after breast surgery: A systematic review of guidelines. Surgeon 2022:S1479-666X(22)00139-1. [PMID: 36593160 DOI: 10.1016/j.surge.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite advances in opioid-sparing analgesia, opioid prescribing in breast surgery remains suboptimal. Besides delayed rehabilitation, excess post-operative opioids may contribute significantly to opioid dependence. This systematic review of guidelines evaluates current opioid-prescribing recommendations after breast surgery to identify trends in prescribing. Additionally, it compares recommendations on different non-opioid and non-pharmacological adjuncts. METHODS Electronic databases were searched systematically using terms "breast surgery", "analgesia", "opioid" and "guidelines". The grey literature was used to supplement the search. All articles that provided guidance on opioid prescribing in breast surgery were included. Quality of the guidelines were assessed using the AGREE II tool. Recommendations pertaining to opioid prescribing, analgesic adjuncts and non-pharmacological interventions were summarised and reported with descriptive statistics. RESULT Eight guidelines pertaining to mastectomies, breast conserving surgery and breast reconstructions were included in this review. Although an opioid-sparing approach was unanimous, there were conflicting recommendations on opioid doses. Opioid requirements were stratified by procedure in 3 guidelines, and by patient risk factors in 2 guidelines. There was significant variability in the recommended multimodal adjuncts. Notably, non-pharmacological interventions such as patient education were infrequently included in guidelines. CONCLUSION There is a lack of high-quality guidance on opioid prescribing after breast surgery. The optimum approach for personalised opioid prescribing remains unknown. Significant variability between guidelines provide little actionable interventions for prescribers. This could be driven by the paucity in evidence supporting a single efficacious analgesic regimen for patients undergoing breast surgery. Future guidelines should also regularly incorporate non-pharmacological adjuncts to reduce opioid prescribing.
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Affiliation(s)
- Kin Yik Chan
- Department of Breast Surgery, University Hospital Limerick, Limerick V94 F858, County Limerick, Ireland.
| | - Shane Keogh
- Department of Breast Surgery, University Hospital Limerick, Limerick V94 F858, County Limerick, Ireland
| | - Nitin Aucharaz
- Department of Breast Surgery, University Hospital Limerick, Limerick V94 F858, County Limerick, Ireland
| | - Anne Merrigan
- Department of Breast Surgery, University Hospital Limerick, Limerick V94 F858, County Limerick, Ireland
| | - Shona Tormey
- Department of Breast Surgery, University Hospital Limerick, Limerick V94 F858, County Limerick, Ireland
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10
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On Application of Injection Procedures in the Management of Post-Breast Surgery Pain Syndrome. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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11
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Baytar Ç, Aktaş B, Aydin BG, Pişkin Ö, Çakmak GK, Ayoğlu H. The effects of ultrasound-guided serratus anterior plane block on intraoperative opioid consumption and hemodynamic stability during breast surgery: A randomized controlled study. Medicine (Baltimore) 2022; 101:e30290. [PMID: 36107549 PMCID: PMC9439800 DOI: 10.1097/md.0000000000030290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM To determine effect of ultrasound-guided serratus anterior plane block (SAPB) on intraoperative opioid consumption in patients undergoing oncoplastic breast surgery under general anesthesia. METHODS This study was conducted as a prospective, randomized controlled trial. Forty-four patients enrolled, aged 18 to 75 years with American Society of Anesthesiologists physical status I to III, undergoing elective oncoplastic breast surgery. Patients were randomly allocated to receive SAPB with 20 mL of 0.25% bupivacaine + general anesthesia (group SAPB) or only general anesthesia (group control). The primary outcome was assessing the effect of SAPB on intraoperative remifentanil consumption. Patients were assessed for emergence time, hemodynamic parameters, doses of rescue drugs used to control hemodynamic parameters, and duration of stay in the recovery room. RESULTS Preoperative SAPB with 0.25% bupivacaine reduced intraoperative opioid consumption (851.2 ± 423.5 vs 1409.7 ± 756.1 µg, P = .019). Emergence time was significantly shorter in group SAPB (6.19 ± 1.90 minutes) compared to group control (9.50 ± 2.39 minutes; P < .001). There were no significant differences in the doses of rescue drugs used for systolic blood pressure and heart rate between the groups. CONCLUSIONS Preoperative SAPB with bupivacaine reduced intraoperative opioid consumption and shortened emergence time and duration of stay in the recovery unit, and hemodynamic stability was maintained without block-related complications.
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Affiliation(s)
- Çağdaş Baytar
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
- *Correspondence: Çağdaş Baytar, Department of Anesthesiology and Reanimation, Faculty of Medicine, Zonguldak Bülent Ecevit University, Esenköy-Kozlu/Zonguldak 67600, Turkey (e-mail: )
| | - Bahar Aktaş
- Department of Anesthesiology and Reanimation, Çaycuma State Hospital, Zonguldak, Turkey
| | - Bengü Gülhan Aydin
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Özcan Pişkin
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Güldeniz Karadeniz Çakmak
- Department of General Surgery, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Hilal Ayoğlu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
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12
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De Cassai A, Zarantonello F, Geraldini F, Boscolo A, Pasin L, De Pinto S, Leardini G, Basile F, Disarò L, Sella N, Mariano ER, Pettenuzzo T, Navalesi P. Single-injection regional analgesia techniques for mastectomy surgery: A network meta-analysis. Eur J Anaesthesiol 2022; 39:591-601. [PMID: 35759292 DOI: 10.1097/eja.0000000000001644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patients undergoing mastectomy surgery experience severe postoperative pain. Several regional techniques have been developed to reduce pain intensity but it is unclear, which of these techniques is most effective. OBJECTIVES To synthesise direct and indirect comparisons for the relative efficacy of different regional and local analgesia techniques in the setting of unilateral mastectomy. Postoperative opioid consumption at 24 h, postoperative pain at extubation, 1, 12 and 24 h, postoperative nausea and vomiting were collected. DESIGN Systematic review with network meta-analysis (PROSPERO:CRD42021250651). DATA SOURCE PubMed, Scopus, the Cochrane Central Register of Controlled Trials (from inception until 7 July 2021). ELIGIBILITY CRITERIA All randomised controlled trials investigating single-injection regional and local analgesia techniques in adult patients undergoing unilateral mastectomy were included in our study without any language or publication date restriction. RESULTS Sixty-two included studies randomising 4074 patients and investigating nine techniques entered the analysis. All techniques were associated with less opioid consumption compared with controls The greatest mean difference [95% confidence interval (CI)] was associated with deep serratus anterior plane block: mean difference -16.1 mg (95% CI, -20.7 to -11.6). The greatest reduction in pain score was associated with the interpectoral-pecto-serratus plane block (mean difference -1.3, 95% CI, -1.6 to - 1) at 12 h postoperatively, and with superficial serratus anterior plane block (mean difference -1.4, 95% CI, -2.4 to -0.5) at 24 h. Interpectoral-pectoserratus plane block resulted in the greatest statistically significant reduction in postoperative nausea/vomiting when compared with placebo/no intervention with an OR of 0.23 (95% CI, 0.13 to 0.40). CONCLUSION All techniques were associated with superior analgesia and less opioid consumption compared with controls. No single technique was identified as superior to others. In comparison, local anaesthetic infiltration does not offer advantages over multimodal analgesia alone. TRIAL REGISTRATION PROSPERO (CRD4202125065).
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Affiliation(s)
- Alessandro De Cassai
- From the UOC Anesthesia and Intensive Care Unit, University Hospital of Padua (ADC, FZ, FG, AB, LP, TP, PN), UOC Anesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy (SDP, GL, FB, LD, NS, PN), Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford (ERM) and Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA (ERM)
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13
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Ludwig K, Wexelman B, Chen S, Cheng G, DeSnyder S, Golesorkhi N, Greenup R, James T, Lee B, Pockaj B, Vuong B, Fluharty S, Fuentes E, Rao R. Home Recovery After Mastectomy: Review of Literature and Strategies for Implementation American Society of Breast Surgeons Working Group. Ann Surg Oncol 2022; 29:5799-5808. [PMID: 35503389 DOI: 10.1245/s10434-022-11799-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/07/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Practices regarding recovery after mastectomy vary significantly, including overnight stay versus discharge same day. Expanded use of Enhanced Recovery After Surgery (ERAS) algorithms and the recent COVID pandemic have led to increased number of patients who undergo home recovery after mastectomy (HRAM). METHODS The Patient Safety Quality Committee of the American Society of Breast Surgeons created a multispecialty working group to review the literature evaluating HRAM after mastectomy with and without implant-based reconstruction. A literature review was performed regarding this topic; the group then developed guidance for patient selection and tools for implementation. RESULTS Multiple, retrospective series have reported that patients discharged day of mastectomy have similar risk of complications compared with those kept overnight, including risk of hematoma (0-5.1%). Multimodal strategies that improve nausea and analgesia improve likelihood of HRAM. Patients who undergo surgery in ambulatory surgery centers and by high-volume breast surgeons are more likely to be discharged day of surgery. When evaluating unplanned return to care, the only significant factors are African American race and increased comorbidities. CONCLUSIONS Review of current literature demonstrates that HRAM is a safe option in appropriate patients. Choice of method of recovery should consider patient factors, such as comorbidities and social situation, and requires input from the multidisciplinary team. Preoperative education regarding pain management, drain care, and after-hour access to medical care are crucial components to a successful program. Additional investigation is needed as these programs become more prevalent to assess quality measures such as unplanned return to care, complications, and patient satisfaction.
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Affiliation(s)
- Kandice Ludwig
- Indiana University School of Medicine, Indianapolis, IN, USA.
| | | | | | - Gloria Cheng
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | - Ted James
- Harvard Medical School, Boston, MA, USA
| | | | | | - Brooke Vuong
- Kaiser Permanente Medical Center, Sacramento, CA, USA
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14
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Mohan SC, Siegel E, Tran H, Ozcan L, Alban R, Shariff S, Mirocha J, Chung A, Giuliano A, Dang C, Anand K, Shane R, Amersi F. Effects of paravertebral blocks versus liposomal bupivacaine on hospital utilization after mastectomy with reconstruction. Am J Surg 2022; 224:938-942. [DOI: 10.1016/j.amjsurg.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022]
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15
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Pawloski KR, Sevilimedu V, Twersky R, Tadros AB, Kirstein LJ, Cody HS, Morrow M, Moo TA. Association Between Local Anesthetic Dosing, Postoperative Opioid Requirement, and Pain Scores After Lumpectomy and Sentinel Lymph Node Biopsy with Multimodal Analgesia. Ann Surg Oncol 2022; 29:1737-1745. [PMID: 34694521 PMCID: PMC11110646 DOI: 10.1245/s10434-021-10981-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/05/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Multimodal analgesia (MMA) during breast surgery reduces postoperative pain and opioid requirements, but the relative contribution of local anesthetic dosing as a component of MMA is not well defined among patients undergoing lumpectomy and sentinel lymph node biopsy (SLNB). PATIENTS AND METHODS We identified consecutive patients who underwent lumpectomy and SLNB with MMA from 1/2019 to 4/2020. Univariable and multivariable linear and logistic regression were used to examine associations between local anesthetics, opioid requirements in the post-anesthesia care unit (PACU), and pain scores in the PACU and on postoperative day (POD) 1. RESULTS In total, 1603 patients [median tumor size, 14 mm (interquartile range 8-20 mm)] were included. The median PACU opioid requirement was 0 morphine milligram equivalents (interquartile range 0-5). PACU maximum pain was none or mild in 58% of patients and moderate to severe in 42%; among 420 survey respondents, 56% reported no or mild pain and 44% reported moderate to severe pain on POD 1. On multivariable analysis that adjusted for routine components of MMA, increasing doses of 0.5% bupivacaine were associated with reduced PACU opioid requirements (β -0.04, 95% confidence interval -0.07 to -0.01, p = 0.011) and lower odds of moderate to severe pain (odds ratio 0.98, 95% confidence interval 0.97-0.99, p < 0.001). Local anesthetics were not associated with pain scores on POD 1. CONCLUSIONS Higher amounts of local anesthetics reduce acute postoperative pain and opioid requirement after lumpectomy and SLNB. Maximizing dosing within weight-based limits is a low-risk, cost-effective pain control strategy that can be used in diverse practice settings.
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Affiliation(s)
- Kate R Pawloski
- Department of Surgery, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Biostatistics Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rebecca Twersky
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Audree B Tadros
- Department of Surgery, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laurie J Kirstein
- Department of Surgery, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hiram S Cody
- Department of Surgery, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Department of Surgery, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tracy-Ann Moo
- Department of Surgery, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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16
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Fiser C, Crystal JS, Tevis SE, Kesmodel S, Rojas KE. Treatment and Survivorship Interventions to Prevent Poor Body Image Outcomes in Breast Cancer Survivors. BREAST CANCER: TARGETS AND THERAPY 2021; 13:701-709. [PMID: 34938117 PMCID: PMC8687859 DOI: 10.2147/bctt.s321721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Caroline Fiser
- Dewitt Daughtry Department of Surgery, University of Miami/Miller School of Medicine, Miami, FL, USA
| | - Jessica S Crystal
- Dewitt Daughtry Department of Surgery, University of Miami/Miller School of Medicine, Miami, FL, USA
| | - Sarah E Tevis
- Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Susan Kesmodel
- Dewitt Daughtry Department of Surgery, University of Miami/Miller School of Medicine, Miami, FL, USA
| | - Kristin E Rojas
- Dewitt Daughtry Department of Surgery, University of Miami/Miller School of Medicine, Miami, FL, USA
- Correspondence: Kristin E Rojas Dewitt Daughtry Department of Surgery, University of Miami, 1295 NW 14th Street, Miami, FL, 33136, USATel +1 305 243-0783 Email
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17
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Lessons Learned: Management of Breast Cancer Patients throughout the COVID-19 Pandemic. CURRENT BREAST CANCER REPORTS 2021; 13:227-234. [PMID: 34804376 PMCID: PMC8596360 DOI: 10.1007/s12609-021-00429-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/20/2022]
Abstract
Purpose of Review The COVID-19 pandemic of 2020 presented a multitude of challenges for physicians nationwide. Standard of care treatment was tailored to protect patients from virus exposure, while delivering safe and adequate care. This article reviews the steps taken to treat and protect breast cancer patients during the pandemic and reentry approaches to resume care. Recent Findings Breast cancer experts rapidly convened to develop treatment guidelines during the pandemic. These recommendations encompass screening approach, prioritization of breast cancer patients, educational modifications, research and data considerations, and a re-entry treatment approach as the pandemic evolved. Without prior experience with a pandemic of this magnitude, these guidelines were based on expert knowledge and previously established data. Summary This emergency forced physicians to operate in a more efficient and effective manner to deliver value-based patient care, and future evaluation of these adjustments will determine if overall patient outcomes were compromised.
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18
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Pawloski KR, Moo TA. ASO Author Reflection: Pain Control Can Be Optimized with Surgeon-Administered Local Anesthesia in Patients Undergoing Lumpectomy and Sentinel Lymph Node Biopsy with Multimodal Analgesia. Ann Surg Oncol 2021; 29:1746-1747. [PMID: 34713372 DOI: 10.1245/s10434-021-11004-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Kate R Pawloski
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tracy-Ann Moo
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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19
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Mariano ER, Dickerson DM, Szokol JW, Harned M, Mueller JT, Philip BK, Baratta JL, Gulur P, Robles J, Schroeder KM, Wyatt KEK, Schwalb JM, Schwenk ES, Wardhan R, Kim TS, Higdon KK, Krishnan DG, Shilling AM, Schwartz G, Wiechmann L, Doan LV, Elkassabany NM, Yang SC, Muse IO, Eloy JD, Mehta V, Shah S, Johnson RL, Englesbe MJ, Kallen A, Mukkamala SB, Walton A, Buvanendran A. A multisociety organizational consensus process to define guiding principles for acute perioperative pain management. Reg Anesth Pain Med 2021; 47:118-127. [PMID: 34552003 DOI: 10.1136/rapm-2021-103083] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/09/2021] [Indexed: 12/22/2022]
Abstract
The US Health and Human Services Pain Management Best Practices Inter-Agency Task Force initiated a public-private partnership which led to the publication of its report in 2019. The report emphasized the need for individualized, multimodal, and multidisciplinary approaches to pain management that decrease the over-reliance on opioids, increase access to care, and promote widespread education on pain and substance use disorders. The Task Force specifically called on specialty organizations to work together to develop evidence-based guidelines. In response to this report's recommendations, a consortium of 14 professional healthcare societies committed to a 2-year project to advance pain management for the surgical patient and improve opioid safety. The modified Delphi process included two rounds of electronic voting and culminated in a live virtual event in February 2021, during which seven common guiding principles were established for acute perioperative pain management. These principles should help to inform local action and future development of clinical practice recommendations.
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Affiliation(s)
- Edward R Mariano
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA .,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - David M Dickerson
- Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA.,Department of Anesthesia & Critical Care, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Joseph W Szokol
- Department of Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Michael Harned
- Department of Anesthesiology, Division of Pain Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Jeffrey T Mueller
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Beverly K Philip
- American Society of Anesthesiologists, Schaumburg, Illinois, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jaime L Baratta
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Padma Gulur
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer Robles
- Department of Urology, Division of Endourology and Stone Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Surgical Service, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Kristopher M Schroeder
- Department of Anesthesiology, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| | - Karla E K Wyatt
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, Texas, USA.,Department of Anesthesiology, Baylor College of Medicine, Houston, Texas, USA
| | - Jason M Schwalb
- Department of Neurological Surgery, Henry Ford Medical Group, Detroit, Michigan, USA
| | - Eric S Schwenk
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Richa Wardhan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Todd S Kim
- Department of Orthopedic Surgery, Palo Alto Medical Foundation, Burlingame, California, USA
| | - Kent K Higdon
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Deepak G Krishnan
- Department of Oral & Maxillofacial Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.,Department of Oral & Maxillofacial Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ashley M Shilling
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Gary Schwartz
- AABP Integrative Pain Care, Brooklyn, New York, USA.,Department of Anesthesiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Lisa Wiechmann
- Department of Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Lisa V Doan
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Nabil M Elkassabany
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Stephen C Yang
- Department of Surgery, Division of Thoracic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Iyabo O Muse
- Department of Anesthesiology, Westchester Medical Center/New York Medical College, Valhalla, New York, USA
| | - Jean D Eloy
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Vikas Mehta
- Department of Otolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Shalini Shah
- Department of Anesthesiology & Perioperative Care, University of California Irvine School of Medicine, Orange, California, USA
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Amanda Kallen
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Ashley Walton
- American Society of Anesthesiologists, Washington, District of Columbia, USA
| | - Asokumar Buvanendran
- Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA
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20
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Dietz JR. Presidential Address: 2020 is Hindsight. Ann Surg Oncol 2021; 28:5468-5472. [PMID: 34420130 PMCID: PMC8380094 DOI: 10.1245/s10434-021-10521-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/15/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Jill R Dietz
- Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
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21
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Pawloski KR, Moo TA. ASO Author Reflections: Non-Steroidal Anti-Inflammatory Drugs are Safe in the Post-Discharge Setting After Lumpectomy and Sentinel Lymph Node Biopsy with Multimodal Analgesia. Ann Surg Oncol 2021; 29:558-559. [PMID: 34387771 DOI: 10.1245/s10434-021-10580-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Kate R Pawloski
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tracy-Ann Moo
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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22
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Pawloski KR, Matar R, Sevilimedu V, Tadros AB, Kirstein LJ, Cody HS, Van Zee KJ, Morrow M, Moo TA. Postdischarge Nonsteroidal Anti-Inflammatory Drugs Are not Associated with Risk of Hematoma after Lumpectomy and Sentinel Lymph Node Biopsy with Multimodal Analgesia. Ann Surg Oncol 2021; 28:5507-5512. [PMID: 34247337 PMCID: PMC8272604 DOI: 10.1245/s10434-021-10446-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022]
Abstract
Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are increasingly used in ambulatory breast surgery. The risk of hematoma associated with intraoperative ketorolac is low, but whether concomitant routine discharge with NSAIDs increases the risk of hematoma is unclear. Methods We retrospectively identified patients who underwent lumpectomy and sentinel lymph node biopsy (SLNB), and compared the 30-day risk of hematoma between patients discharged with opioids (opioid period: January 2018–August 2018) and patients discharged with NSAIDs with or without opioids (NSAID period: January 2019–April 2020). The association between study period and hematoma risk was assessed using multivariable models. Covariates included intraoperative ketorolac, home aspirin, and race/ethnicity. During the NSAID period, a survey was used to assess analgesic consumption on postoperative days 1–5. Results In total, 2724 patients were identified: 858 (31%) in the opioid period and 1866 (69%) in the NSAID period. In the NSAID period, 867 (46%) received NSAIDs and opioids, and 999 (54%) received NSAIDs only. Receipt of intraoperative ketorolac was higher in the NSAID period (78 vs. 64%, P < 0.001). The risks of any hematoma (4.1 vs. 3.6%, P = 0.6) and reoperation for bleeding (0.5 vs. 0.6%, P = 0.8) were similar between groups. Study period was not associated with hematoma risk (odds ratio 0.87, 95% confidence interval 0.56–1.35, P = 0.5). Among survey respondents (41%), nonopioid analgesic consumption did not increase after opioids were removed from the discharge regimen (median, 6 pills/group, P = 0.06). Conclusions NSAIDs are associated with a low risk of hematoma after lumpectomy and SLNB, and should be prescribed instead of opioids, unless contraindicated.
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Affiliation(s)
- Kate R Pawloski
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Regina Matar
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Laurie J Kirstein
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Hiram S Cody
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Kimberly J Van Zee
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Tracy-Ann Moo
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
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23
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Morin C, Borgen PI, Rojas KE. ASO Author Reflections: The Time to Incorporate Opioid-Minimizing Initiatives in Your Institution is now. Ann Surg Oncol 2021; 28:5865-5866. [PMID: 33877480 PMCID: PMC8057002 DOI: 10.1245/s10434-021-09966-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Claudya Morin
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Patrick I Borgen
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Kristin E Rojas
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
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24
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Kuerer HM, Blair SL. The Virtual Scientific Sessions from the American Society of Breast Surgeons During the COVID-19 Pandemic. Ann Surg Oncol 2020; 27:4585-4587. [PMID: 32812104 PMCID: PMC7433665 DOI: 10.1245/s10434-020-08946-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Henry M Kuerer
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Department of General Surgery, University of California, San Diego, CA, USA.
| | - Sarah L Blair
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of General Surgery, University of California, San Diego, CA, USA
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