Underutilization of Enhanced Recovery After Surgery (ERAS) in Breast Surgery: An Opportunity to Reduce Opioid Usage

Abstract

Over a 20-year period, opioid-related deaths in the United States have increased sixfold. 1 In 2017, therefore, the Department of Health and Human Services officially declared this rapid increase in drug-related mortality a public health emergency. During that year, according to the Centers for Disease Control (CDC), more than 70,200 people died from drug overdoses; roughly 47,700 of those deaths involved opioids. Therefore, more people now die of opioid abuse or misuse annually than die of breast cancer. 2 Although this trend is multifactorial, a sharp increase in the number of opioid prescriptions is considered an important-and addressable-cause. 3 Despite the opioid crisis being a government and public health priority, the CDC offers little guidance for managing acute postsurgical pain. Although there are CDC pain management guidelines, they are written for primary care providers and make recommendations only for the treatment of chronic pain. 4 It has, therefore, been up to individual institutions and professional societies to create protocols for controlling surgical pain while addressing the new mandate to prevent opioid dependence. In this issue, Rao et al. 5 report the current breast and axillary surgery analgesia practices of members of the American Society of Breast Surgeons (ASBrS), and present the Society's perioperative pain control consensus statement. Roughly 20% of the 3000 ASBrS members who were invited to take the electronic survey responded. They were queried for methods of pain control used (local anesthesia, blocks, nonsteroidal anti-inflammatory drugs