The opioid epidemic is propelling surgeons to seek non-narcotic approaches for managing postoperative pain. Cleveland Clinic Breast Center is leading a quality control initiative that aims to improve safety and pain management by educating patients, collecting prescribing and usage data, improving non-opiate pain control and reducing opiate prescribing.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
“We are excited about finding new ways to manage pain,” says Stephanie Valente, DO, Director of the Breast Surgery Fellowship Program at Cleveland Clinic. “Surgeons have an obligation to treat their patients’ postoperative pain, but also to follow appropriate prescribing behavior and avoid overprescribing. If we are effective at managing pain, patients won’t need as much pain medication.”
The initiative is focusing on pain control using multimodal analgesia, a critical component of enhanced recovery after surgery (ERAS) protocols. In recent years, ERAS protocols, which include preoperative optimization, prevention of surgical complications, reduction of physiological stress response to surgery and rehabilitation to normal function, have gained broad acceptance by many surgical specialties. Studies have found that ERAS protocols decrease length of stay (LOS), improve quality of care and reduce healthcare costs.
Multimodal analgesia uses different mechanisms to control pain, including local infiltration of an anesthetic following surgery. The short-acting anesthetic bupivacaine is commonly used with additional pain medication, usually opioids. Exparel®, a bupivacaine formulation that is encased in liposome to provide extended pain relief for up to three days (the usual number of days that patients require opiates for postoperative pain), has been shown to decrease the need for postoperative opioids in numerous surgeries, including immediate breast reconstruction following mastectomy.
As part of the initiative, the Breast Center is conducting a prospective study to evaluate the effectiveness of combination Exparel/Marcaine given as a field block to reduce postoperative pain in mastectomy patients and decrease the need for narcotic use. Over a year, researchers will evaluate the opiate requirements of mastectomy patients after the above quality measures are instituted. The study’s hypothesis is that patients undergoing mastectomy can have postoperative pain completely managed with local surgical site infiltration so they need only non-opioid pain relievers.
“We will learn whether infiltration of pain medications at the surgical site with longer lasting drugs such as Exparel, in combination with patient education and other multimodal therapies, can effectively and completely control postoperative pain. The ability to administer pain medicine only at the surgical site will allow a patient to have minimal pain at home and be able get back to normal activities sooner without the need for opiates,” says Dr. Valente.
First-of-its-kind research investigates the viability of standard screening to reduce the burden of late-stage cancer diagnoses
Study demonstrates ability to reduce patients’ reliance on phlebotomies to stabilize hematocrit levels
Findings highlight an association between obesity and an increased incidence of moderate-severe disease
Cleveland Clinic Cancer Institute takes multi-faceted approach to increasing clinical trial access
Key learnings from DESTINY trials
Gene editing technology offers promise for treating multiple myeloma and other hematologic malignancies, as well as solid tumors
Study of 401,576 patients reveals differences in cancer burdens as well as overall survival
Enfortumab plus pembrolizumab reduced risk of death by 53% compared with platinum-based chemotherapy