P026: REVIEW OF NON-OPIOID ACUTE PAIN MANAGEMENT FOLLOWING MASTECTOMIES
Valeria Nieri1; Jane Hufnagel1; Annika N Lundberg1; Iman A Majid1; Alana M Cruickshank1; Pierce A Imperialbobis1; Madison R McCraney, MPH1; Antonia A Nemec, PhD2; Shlermine Everidge, MD3
1Florida State University College of Medicine; 2Department of Biomedical Sciences, Florida State University College of Medicine; 3Department Of Breast Surgical Oncology, Tallahassee Memorial Hospital
Introduction/Background: In 2019, the incidence of breast cancer in America was reported at 137.7 new cases per 100,000 females. In light of the growing epidemic of substance abuse and addiction in the US, importance has been placed on the use of multimodal pain regimens in the postoperative setting. This review aims to synthesize a comprehensive overview of the non-opioid medications commonly used in post-mastectomy pain management regimens.
Methods: Mastectomies with immediate post-operative reconstruction and radical mastectomies were excluded due to extended completion times and significantly increased pain associated with axillary nerve bundle involvement, respectively.
Results: The literature suggests that selective COX-2 inhibitors were potentially more effective than non-selective NSAIDs, which demonstrated moderate effectiveness in combating post-mastectomy pain management. NSAIDs are beneficial for reducing inflammation and inflammation-related pain. However, the dosing should be carefully considered in older populations and those with renal dysfunction. Acetaminophen, a similar alternative to NSAIDs, also demonstrated moderate effectiveness with a decreased risk for bleeding and nephrotoxicity. The use of gabapentin was shown to reduce pain associated with rest and movement when administered to patients one hour before surgery. Postoperatively, it was also shown to lower total morphine consumption. Data was limited on the effectiveness of the 5% transdermal lidocaine patch for acute post-mastectomy pain. Nerve blocking agents were found to significantly reduce post-operative pain ratings, leading to later requests for morphine within a 24-hour period. Thoracic paravertebral nerve blocks were shown to have a significantly more consistent sensory blocking effect over a greater dermatomal area immediately after surgery compared to erector spinae nerve blocks.
Discussion/Conclusion: Pain management is a crucial factor in influencing post-mastectomy surgical recovery. With the growing epidemic of substance abuse, a balance between optimal pain management and opioid addiction potential should be deliberated. Various multimodal approaches with non-opioid medications are available for post-operative pain management, but careful consideration of the benefits versus side effects of each should be weighed for each patient.