The Mayo Clinic is using an innovative approach that emphasizes pain control with less use of intravenous opioids to facilitate easier, quicker recovery for women who have breast reconstruction after mastectomy.
Enhanced recovery pathway (ERP) is an evidence-based approach that was developed in Denmark more than 15 years ago. Patient feedback and studies show that ERP works, although many of the components contradict standard pre- and post-op practices. ERP patients are not required to fast prior to surgery (they may have a small meal the night before their operation and a protein beverage the morning of surgery), and contrary to standard post-surgery procedure, they are encouraged to rehydrate in the recovery room and to eat shortly thereafter.
Mayo Clinic plastic surgeon Michel Saint-Cyr worked with anesthesiologists, pharmacists and nursing staff to develop a unique ERP for breast reconstruction patients. The protocol has been so successful, it is now used for all plastic surgeries at the Mayo Clinic. Compared to traditional methods, the new approach includes preoperative analgesics to help prevent pain, nonsteroidal anti-inflammatories, preventive nausea treatment, and use of an inoperative nerve-numbing agent at the surgical site.
In a study of 48 women who had free flap breast reconstruction at the Mayo Clinic, 31 individuals who experienced ERP reported significant postoperative improvements compared to the 17 patients who did not receive ERP, including:
· Ambulatory within 24 hours of surgery.
· Reduced pain (ranging from 0 to 4 on a scale of 10, compared to 6 to 8).
· Reduced (by half) use of opioid painkillers.
· Less pain reported 24 hours after surgery.
· Shorter hospital stay (an average of 3 days compared to 4½).
· Acetaminophen rather than narcotics were sufficient for many upon leaving the hospital.
· Resumed driving and returned to work in 2–3 weeks, compared to 4 to 6