Melanoma Surgery
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Sentinel Lymph Node Biopsy Only
0-5
SUPPORTING LITERATURE
Lee et al. 2019 (Level 2 evidence)
- DOI: http://doi.org/10.1245/s10434-018-6772-3
- Analyzed data from 847 patients who underwent breast or melanoma procedures between June 2016-September 2017 at a single institution.
- Mastectomy or wide local excision for melanoma: mean opioid prescribed = 13 pills
- Lumpectomy or breast biopsy: mean opioid prescribed = 12 pills (oxycodone 5 mg)
Wide Local Excision ± Sentinel Lymph Node Biopsy
0-20
SUPPORTING LITERATURE
Lee et al. 2019 (Level 2 evidence)
- DOI: http://doi.org/10.1245/s10434-018-6772-3
- Analyzed data from 847 patients who underwent breast or melanoma procedures between June 2016-September 2017 at a single institution.
- Mastectomy or wide local excision for melanoma: mean opioid prescribed = 13 pills
- Lumpectomy or breast biopsy: mean opioid prescribed = 12 pills (oxycodone 5 mg)
OPIOID PRESCRIBING
When an opioid is needed after surgery, use the OPEN prescribing recommendations as the foundation for a shared decision-making conversation with the patient to determine the best prescription size.
It’s important to note that these are not rigid rules that must be adhered to, but rather recommendations. Starting form a standardized approach and then allowing for individualization helps promote both equity and patient-centeredness.
- Determine the opioid prescribing range based on:
- Type of procedure
- Additional procedures performed
- With the patient, determine the best prescription size within the appropriate range
- Assess for individual risk factors
- Consider patient preferences and other non-opioid strategies utilized
- Pain management at the time of discharge:
- Pain scores in 24 hours prior to discharge
- Medication use in 24 hours prior to discharge
- Timing of discharge
