Opioid Consumption Following Breast Reconstruction Decreases With a Brief Educational Intervention: A Randomized, Controlled Trial

Abstract

PURPOSE: There has been a focus on opioid consumption and overprescribing, but the utility of patient education in reducing opioid consumption has only recently been explored. This randomized trial aimed to evaluate the effectiveness of a brief patient educational intervention in reducing pain and opioid consumption in patients undergoing mastectomy and breast reconstruction. We hypothesized that implementation of an educational intervention on pain control would decrease postoperative opioid consumption. METHODS AND MATERIALS: A parallel, randomized, single-center controlled trial of women undergoing mastectomy and immediate, implant-based breast reconstruction was completed to evaluate the utility of a patient educational instrument. The control group received standard patient counseling, and the treatment group received an additional single-paged handout intervention. Goals of the educational instrument were to normalize the pain experience, set expectations for pain after surgery, and inform patients of alternative (nonopioid) methods of pain control. A questionnaire was administered postoperatively to collect data on pain control and opioid consumption. RESULTS: Over a 12-month time period, 100 patients were randomized. A total of 46 participants from the control group (92%) and 39 participants from the intervention group (78%) completed the postoperative questionnaire. Postoperative questionnaires were completed a median of 13.0 days after surgery in both groups. Review of the electronic medical record showed similar demographics and comorbidities between the control and intervention groups; however, participants in the control group were statistically more likely to be a current tobacco user (P = 0.04). There were no statistical differences in surgical characteristics or postoperative prescriptions between the 2 groups. All outcome analysis was performed according to intended treatment groups. A statistically significant reduction in the number of opioid tablets consumed was seen in the intervention group (control 24.3, SD 21.8; intervention 16.2, SD 16.4; P = 0.05). Although immediate postoperative prescriptions were equivalent between the 2 groups, more participants in the control group required a prescription refill compared to the intervention group (control n = 10, 21%; intervention n = 6, 12%; χ2 = 1.3; P = 0.3). Due to the differences in need for prescription refill, the total average number of opioid tablets prescribed to the control group was statistically higher than the intervention group (control 46.6, SD 21.8; intervention 39.2, SD 11.9; P = 0.04). There was a marginal trend toward lower average postoperative pain scores reported by the intervention group (control 3.6/10, SD 1.6; intervention 3.0/10, SD = 1.8; P = 0.06). CONCLUSIONS: This study was successful in trialing an easily implemented, brief intervention. When tested in a randomized population of breast reconstruction patients, the instrument was found to reduce opioid consumption, while maintaining noninferior pain control and need for opioid refills. The effectiveness of a brief patient education tool on patient opioid consumption has been shown, and implementation of similar protocols in this patient population is recommended.