Reducing Narcotic Prescriptions in Breast Surgery: A Prospective Analysis.

Background: No clear standards regarding number or type of narcotics for adequate postoperative pain control have been established in breast surgery. The authors of this study reviewed their opioid-prescribing patterns and implemented a planned change, evaluated the effectiveness of a departmental practice adjustment, and prospectively evaluated patient narcotic usage.

Methods: The narcotic prescriptions for 100 consecutive breast surgery patients were reviewed to establish baseline postoperative narcotic-prescribing patterns. The median of narcotics prescribed was used to educate surgeons and implement a planned change in prescribing practices. Data on narcotic prescriptions for 100 consecutive breast surgery patients then were prospectively collected, and the number of pain pills the patients actually took after discharge was recorded using a standardized template.

Results: A baseline review of narcotic-prescribing practices showed that the median number of pills given was 15 for excisional biopsy/lumpectomy, 20 for mastectomy, and 28 for mastectomy with reconstruction. After departmental education, the median number decreased to 10 for excisional biopsy/lumpectomy (p < 0.01) and 25 for mastectomy with reconstruction (p < 0.01). Prospective recording of patient usage compared with the prescribed number of pills indicated that most prescribed pills were not used, with the excisional biopsy or lumpectomy patients using a median of 1 pill (p < 0.01), the mastectomy patients using a median of 3 pills (p < 0.01), and the mastectomy with reconstruction patients using a median of 18 pills (p < 0.01) postoperatively. Only three patients, all of whom had breast reconstruction performed, required a refill of narcotics.

Conclusions: Successful reduction in narcotic prescriptions can be implemented for breast surgery patients. Further reductions in narcotic prescriptions may be feasible based on prospective collected patient usage.