129. Assessment of Multimodal Non-Opioid Analgesia in Postoperative Pain Management for Gender-Affirming Mastectomy

PURPOSE: The opioid crisis has underscored the need for alternative approaches to postoperative pain management, particularly in vulnerable populations as patients undergoing gender-affirming mastectomy (GAM). These individuals may face heightened risks of opioid misuse due to psychological stressors related to gender dysphoria and societal stigma. Despite efforts to reduce opioid use, data on the efficacy of non-opioid analgesic regimens in GAM remains limited. Previous research from our institution found that regional nerve blocks did not significantly improve postoperative pain control to opioid-inclusive regimens (OIR). With the rise in gender-affirming surgeries, optimizing pain management strategies is essential. This study aims to evaluate the effectiveness of multimodal non-opioid analgesic regimen (NOAR) in managing postoperative pain GAM patients. METHODS: This prospective study compared patients undergoing GAM with NOAR to a historical cohort treated with OIR at a single institution. Patients under 18 years of age, with opioid use disorder, chronic pain, or neuropathy were excluded. The NOAR group was discharged with gabapentin (100 mg) and acetaminophen (500 mg) for pain management. Pain levels were recorded using a visual analog (VAS) and medication use tracked during the first postoperative week. One month after surgery, patients completed an online recovery survey. NOAR outcomes were compared to the OIR group, which received hydrocodone (5 mg). Statistical analysis was performed using descriptive statistics and t-tests in Stata version 17.0 (College Station, TX, USA). RESULTS: Twelve patients in the NOAR group were compared to 21 in the OIR group. There were no significant differences in age (27.5 vs. 30.1 years, p=0.46) or surgery duration (156.0 vs. 142.0 minutes, p=0.16) between groups. Pain scores during the first week were comparable, with averages ranging from 2.0 to 3.5 in the OIR group and 2.3 to 4.0 in the NOAR group. Early pain scores at two- and four-hours post-surgery were higher in the NOAR group (4.0 vs. 2.57, p=0.03; 4.0 vs. 2.72, p=0.48). Opioid consumption peaked on postoperative days 0 and 1, while non-opioid medication use peaked on days 3 and 4. Pain scores in the OIR group trended below 3 by post-operative day 2, while the NOAR group reached this threshold on post-operative day 3. One-month postoperative recovery scores in the NOAR group averaged 8.6/10 across domains of physical health, psychological well-being, and social well-being. CONCLUSION: Preliminary findings suggest that a multimodal non-opioid analgesic regimen (NOAR) is an effective alternative to opioid-inclusive regimens (OIR) in managing postoperative pain following GAM. Although early pain scores were higher in the NOAR group, overall pain control was similar between groups during the first week. NOAR also demonstrated positive recovery outcomes at one-month post-op. Further research with larger cohorts and long-term follow-up is needed to confirm these findings and assess whether NOAR can reduce opioid-related complications such as dependence or misuse in this population.