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Surgical protocol reduces opioid use for breast reconstruction patients

Breast cancer surgeries can be quite painful, so a team at Houston Methodist West Hospital has worked to develop pain management protocols that help some patients while reducing the use of narcotics.

Dr. Candy Arentz, a breast surgical oncologist, and Dr. Warren Ellsworth, a plastic surgeon, have been using an enhanced recovery after surgery (ERAS) protocol with non-narcotic medications and nerve blocks to lessen pain and the need for narcotics in reconstructive surgeries.

A DIEP flap reconstruction uses tissue and fat from the abdomen and other areas to reconstruct the breast after a lumpectomy or a mastectomy. Ellsworth said the reconstruction can be beneficial because it can look more natural than implants and can last the rest of a patient’s life. But it can be more painful because of the extra incisions. He recognizes that opioid overuse is an issue and said that is just one reason why he and Arentz are working to reduce opioid use.

“We have also, I would say, across the entire house of medicine known about this opioid overuse, opioid dependence and all these challenges that our narcotics impose on our patients, not only the basic side effects of narcotics like nausea, vomiting, constipation, but of course, the dependency,” Ellsworth said.

The ERAS protocol helps patients with pain starting the day before the surgery. “So it prepares their body for the surgery and the pain that could occur, and then we continue the pain control throughout the surgery and then of course postoperatively and have found a significant reduction in the use of narcotics because of this protocol,” Ellsworth said.

As Arentz and Ellsworth were coming up with the protocol, Ellsworth consulted with plastic surgeons at the University of Pennsylvania and Stanford University, modeling the Methodist West protocol after their programs. But according to Ellsworth, Methodist West is the first in the Houston area to make the non-narcotic protocols a priority with their patients in the area of DIEP flap reconstructions.

Ellsworth said starting ERAS required bringing in others in the hospital on board, including the head of anesthesiology so that anesthesiologists could administer nerve blocks, or long-lasting numbing injections into patients’ nerves, and the head of the ICU (intensive care unit) because the new protocols were a big change in pain management. Arentz said it required patient buy-in as well.

“It starts with our conversations in clinic and assuring the patients that they will have decreased pain afterwards than probably what they were expecting,” Arentz said, adding that the protocol is done without using IV medications, which is what most people expect when they are going to have surgery.

Arentz and Ellsworth had planned to start using ERAS in February or March, but COVID-19 shifted it back some. So they started in April. Ellsworth said that all

HPV vaccine ‘substantially’ reduces cervical cancer risk: study

Human papillomavirus (HPV) vaccination substantially lowered the risk of cervical cancer, especially when administered early, according to a new study.

Researchers in Sweden published their findings on Thursday in the New England Journal of Medicine, and said evidence was otherwise lacking on the issue.

The study found that those vaccinated before age 17 had an 88% lower risk of cervical cancer than those never vaccinated.

Human papillomavirus (HPV) vaccination substantially lowered the risk of <a data-cke-saved-href="" href="" target="_blank">cervical cancer</a>, especially when administered early, per a new study.<br data-cke-eol="1">

Human papillomavirus (HPV) vaccination substantially lowered the risk of <a data-cke-saved-href=”” href=”” target=”_blank”>cervical cancer</a>, especially when administered early, per a new study.<br data-cke-eol=”1″>


“HPV is the most common sexually transmitted infection,” according to the Centers for Disease Control and Prevention (CDC). Those with weakened immune systems may have more difficulty fighting the virus, which can lead to health issues like genital warts and cancers. The CDC recommends two doses of the HPV vaccine for boys and girls aged 11 to 12, though vaccination can start as young as age 9. Pushing off vaccination may result in needing three doses instead of two, the agency said.

The study followed nearly 1.7 million females ages 10 to 30 living in Sweden from 2006 through 2017 to find the association between HPV vaccination and the risk of cervical cancer. Among those vaccinated, 438,939, or 83%, started vaccination before age 17.


Early vaccination is associated with lower risk of cervical cancer, per the study. (iStock)

Early vaccination is associated with lower risk of cervical cancer, per the study. (iStock)

Cervical cancer was diagnosed in 19 women who were vaccinated and 538 women who were not.

“Although the efficacy and effectiveness of the HPV vaccination against HPV infection, genital warts, and high-grade cervical lesions have been established, our results extend this knowledge base by showing that quadrivalent HPV vaccination is also associated with a substantially reduced risk of invasive cervical cancer, which is the ultimate intent of HPV vaccination programs,” study authors wrote.


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