Pilot Study: Evaluation of the Feasibility of a Multimodal Analgesia Protocol for Primary Breast Augmentation Patients.

[BACKGROUND] The opioid epidemic remains an issue in the United States. Multiple studies have demonstrated that prescription opiates are overprescribed following surgery, with evidence showing that more than 50% are not used. The opioid epidemic has led to the development of enhanced recovery after surgery protocols, with an emphasis on multimodal analgesia (MMA) as an alternative. The aim of this pilot study was to evaluate the feasibility of a newly implemented MMA protocol in primary breast augmentation.

[METHODS] A protocol including preoperative, intraoperative, and postoperative components was implemented by 4 plastic surgeons at the University of Nebraska Medical Center. Thirty-five female patients were included. Protocol failure was defined as the use of opioids after discharge, and postoperative pain was assessed twice using the Brief Pain Inventory form.

[RESULTS] The median age and body mass index for patients were 37 years and 22.2 kg/m, respectively. All patients received subpectoral implants, with silicone being the most common implant (91.4%). The majority of patients received full-profile implants (57.1%). Of the 35 patients enrolled, the protocol failed in 2 (5.7%) patients. There was a significant negative correlation between patient age and the average pain score reported on postoperative day 1 ( = -0.35, = 0.04). There was no significant difference in pain scores demonstrated between different implant profiles ( = 0.84).

[CONCLUSIONS] MMA for outpatient breast augmentation was successful and may be an effective alternative to opioids. Younger patients reported higher average pain scores postoperatively and may be more likely to require opioids.