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Researchers found that setting guidelines for opioid prescriptions in patients undergoing breast cancer surgery modestly reduced the number of pills dispensed -- but perhaps more importantly, most patients took only a fraction of the pills they were given.

The guidelines recommended 10 pills for excisional biopsy or lumpectomy, 20 for mastectomy, and 25 for mastectomy with reconstruction surgery. Three months after they were implemented, the median number of pills prescribed hit those targets exactly among 103 patients analyzed, reported Stephanie Valente, DO, of the Cleveland Clinic in Ohio, and colleagues.

But the number of pills actually taken by patients was even lower -- much lower in some cases, they reported at the .

The median in excisional biopsy/lumpectomy patients was a single pill; for mastectomy patients it was three pills. Only patients undergoing mastectomy with reconstruction used most of what they were prescribed, with a median of 18 pills.

In fact, 40% of patients reported not using narcotics at all after surgery, and just three patients who received a mastectomy with reconstruction refilled their prescription after their initial postoperative visit.

"After the departmental planned change, we observed that, as planned, a statistically significant decrease in prescribing practices among surgeons was able to be performed, showing surgeons were able to adhere to these new prescribing practices," Valente said while presenting the findings.

Surgeons may overestimate the number of narcotics that should be prescribed for postoperative pain and many of the pills they prescribe may go unused and be at risk for diversion, Valente said.

Other studies have shown that the more pills that are prescribed to patients, the more they will take, and that, in fact, women undergoing various types of surgery do not need as many opioids as their providers are prescribing them.

In order to reduce the number of opiates prescribed, it's important for surgeons to prepare patients on what to expect postoperatively, said Deanna Attai, MD, of the University of California Los Angeles, who was not involved with this study. This involves discussing other pain management tactics, such as wearing a supportive bra to reduce discomfort along an incision line, or splitting pills to keep dosages to the minimum needed, she added.

Surgeons can also use a long-acting local anesthetic in the operating room to help ease postoperative pain, Attai said.

"I think proper patient education and setting the expectations can go a long way towards reducing narcotic use as well," Attai told MedPage Today.

For this study, Valente and her team first retrospectively reviewed 100 consecutive patients treated at their center across one month in 2017, to inform development of the guideline. At that time, median pill prescriptions were 15 for excisional biopsy or lumpectomy, 20 for mastectomy, and 28 for mastectomy with reconstruction. After the guidelines were implemented, women reported how many pills they used through a follow-up survey.

Overall, the number of pills prescribed before the implemented changes ranged from 0 to 40, and included tramadol, acetaminophen/codeine, acetaminophen/hydrocodone, and acetaminophen/oxycodone, the authors reported.

Valente said future research should investigate whether the type or amount of local anesthetic given to patients affects the number of pain pills they are administered and take postoperatively. She added that future studies could also identify whether certain patient characteristics are associated with narcotic intake.

"Reducing the number of postoperative narcotic pills in breast cancer surgery patient prescribing is feasible," Valente concluded. "Further reductions may be possible based on our patient-reported consumption patterns."

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