Pre-Operative Multimodal Analgesia Decreases Post-Anesthesia Care Unit Narcotic Use and Pain Scores in Outpatient Breast Surgery

Background: The opioid epidemic demands changes in perioperative pain management. Of the 33,000 deaths due to opioid overdose in 2015, half received prescription opioids. Multimodal analgesia (MMA) is a practice-altering evolution that reduces reliance on opioid medications. Ambulatory breast surgery is an ideal opportunity to implement these strategies. Methods: A retrospective review of 560 patients undergoing outpatient breast procedures was conducted. Patients received 1) no pre-operative analgesia (n=333), 2) intra-operative IV acetaminophen (n=78), 3) pre-operative oral acetaminophen and gabapentin (n=95), or 4) pre-operative oral acetaminophen, gabapentin and celecoxib (n=54). Outcomes included PACU narcotic use, pain scores, PACU length-of-stay, rescue anti-emetic use and 30-day complications. Results: Both oral MMA regimens significantly reduced PACU narcotic use (GA:14.3 +/- 1.7 and GAC:11.9 +/- 2.2 versus no drug:19.2 +/- 1.1 mg oral morphine equivalents, p=0.0006), initial pain scores (GA:3.9 +/- 0.4 and GAC:3.4 +/- 0.7 versus no drug:5.3 +/- 0.3 on a 1-10 scale, p=0.0002) and maximum pain scores (GA:4.3 +/- 0.4 and GAC:3.6 +/- 0.7 versus no drug:5.9 +/- 0.3, 1-10 scale, p