ABSTRACT: COMPARISON OF TRADITIONAL AND ENHANCED RECOVERY AFTER SURGERY PROTOCOLS AMONG WOMEN UNDERGOING MASTECTOMY

Background and aims: Acute post-surgical pain is difficult to manage in patients undergoing breast cancer surgery. An ERAS protocol for mastectomy patients was developed in 2016. This study aims to compare pain scores, narcotic use, postoperative nausea and vomiting and antiemetic administration between postoperative mastectomy patients who received Traditional Recovery After Surgery (TRAS) or the ERAS protocol.Methods: A retrospective chart review of TRAS and ERAS for mastectomy surgery was designed. A statistical power analysis determined a necessary sample size of 102. Two groups were evaluated: 51 patients having mastectomy surgery from January to May 2016, prior to ERAS implementation, and 51 patients having mastectomy after implementation of ERAS protocols.Results: No significant differences were found between the groups in terms of demographics or pain history. A significant difference was found on POD0 between TRAS and ERAS groups in antiemetic use, mean and max pain scores with ERAS being significantly lower. Oral morphine equivalent intake was significantly less on POD0 and POD1 in the ERAS group. On POD0 the oral morphine equivalent was 58.3 mg for TRAS compared with 26.7mg for ERAS and on POD1 was 20.8 mg for the TRAS group, significantly higher than the 4.7 mg average in the ERAS group. Conclusions: The incorporation of ERAS measures into the surgical care for mastectomy surgery can positively affect recovery. This ERAS protocol may improve pain control, reduce PONV, and reduce opioid adverse events.