D151. Inpatient And Outpatient Opioid Use After Intraoperative Methadone Implementation in Autologous Breast Reconstruction

PURPOSE: This study evaluates the effectiveness of our Enhanced Recovery After Surgery (ERAS) protocol, which features a unique component: a single dose of intraoperative methadone, in patients undergoing DIEP-flap breast reconstruction. METHODS: We retrospectively reviewed 125 DIEP-flap reconstruction patients to form a historical control group (2018-2021). After implementing the methadone-based ERAS protocol, 125 patients were prospectively enrolled in the ERAS cohort. Inpatient vital signs, pain scores, and opioid use were assessed. Additionally, ERAS patients were surveyed for 14 days post-discharge to monitor home opioid use. RESULTS: Non-ERAS and ERAS cohorts were similar in demographics, comorbidities, and intraoperative characteristics. ERAS patients had significantly shorter hospital stays (2.6 vs. 3.0 days, p<0.001) and significantly lower postoperative pain scores compared to non-ERAS patients. Their average heart rate was also significantly lower postoperatively, while mean arterial and systolic pressures were comparable. The ERAS cohort consumed significantly less total opioids during admission (96.5 vs. 132.1 MME, p<0.001) and were prescribed less opioids at discharge (110 vs. 158 MME, p<0.001); refill rates were similar (21% ERAS vs. 23% non-ERAS). Among the 75 ERAS patients who completed the home survey, most took an average of nine oxycodone 5mg pills after discharge and stopped opioid use entirely by home day-four. CONCLUSION: Our methadone-based ERAS protocol reduced postoperative pain levels, heart rates, opioid consumption, and length of hospitalization.