Breast Surgery Without Opioids

“I absolutely cannot handle narcotics,” said Cathy Kalimon, after learning that treating her breast cancer would mean surgery and anesthesia.

Cathy received her diagnosis in December 2015 shortly after she and her husband John returned from a getaway in the Shenandoah Mountains. Days later, Cathy met with breast surgeon Eleni Tousimis, MD and breast reconstruction surgeon Troy Pittman, MD. Cathy was scheduled for two surgeries. One surgery included two procedures in the same operation: a bilateral mastectomy with breast reconstruction. 

Cathy’s previous surgeries with standard anesthesia left her with unbearable nausea and vomiting. Dr. Tousimis comforted Cathy to let her know she had not forgotten her concern and introduced Cathy to her anesthesiologist.

“When she opened the office door, there he was! Dr. Wonderful!” Cathy said with a chuckle. “Or at least that's what I call him.”

Joseph Myers, MD is the anesthesiologist who developed the ComfortSafe Pyramid®, an alternative approach to anesthesia that can relieve pain without narcotics and their side effects.  The ComfortSafe Pyramid® is a checklist that prompts anesthesiologists to consider all the alternative pain relieving choices before a patient regains consciousness after surgery.

Many patients who undergo surgery with ComfortSafe experience:

• Less pain
• Less nausea
• Less confusion
• Awaken more rapidly
• A reduced risk of narcotic addiction
• Often return home sooner

The ComfortSafe technique was originally developed for the sickest patients in the hospital. Dr. Myers discovered that these sick patients, who could not tolerate standard anesthesia, did not need narcotics.

In February 2016, the American Pain Society published new Guidelines on the Management of Postoperative Pain in The Journal of Pain. The guidelines provide strong recommendations for using a variety of non-narcotic techniques and avoiding opioids when unnecessary. Aligning with these recommendations, the goal of ComfortSafe is to achieve maximum pain relief for all patients, with the fewest number of side effects.

“There are people who are terrified of anesthesia or have had such problems with anesthesia that sometimes they cannot bring themselves to have life-saving surgery. ComfortSafe can help these people make a good decision for their health,” said Dr. Myers. “It’s exciting to see progressive and forward-thinking surgeons willing to collaborate with the anesthesiologists to benefit our patients.”

The collaboration between Dr. Tousimis, Dr. Pittman and Dr. Myers began in 2015 after discussing a research project, which included questions about pain. Together the doctors developed a non-narcotic anesthesia protocol for breast surgery patients.   

"I have always had a strong interest in reducing pain after breast cancer surgery," said Dr. Tousimis. “If a patient has a pain-free recovery, they breathe better, get out of bed sooner and have a faster recovery with a better outcome.”

“ComfortSafe is a total game changer and unique to MedStar Georgetown,” added Dr. Pittman. “One of the hardest parts of the journey through breast cancer is loss of control. The nausea, pain and disconnection associated with narcotics is the epitome of that loss of control. Patients simply do not want to feel sick and helpless. With ComfortSafe, all of this is minimized.”

Cathy felt her sense of control return immediately after meeting with her doctors for the first time.

“People hear ‘surgery’ and they automatically expect the worst, but I was so pleased to meet with all the members of my surgical team at MedStar Georgetown,” said Cathy. “I just remember thinking that I was so glad someone was finally going to listen to my concerns about the side effects of narcotics!”

Grateful for a smooth recovery, Cathy encourages patients to ask questions about their anesthesia and anesthesiologists while researching for surgeons.

“My experience with ComfortSafe in comparison to normal anesthesia is like night and day!” she said.

Since ComfortSafe is not limited to breast surgery patients who are in need of an alternative anesthesia method, Dr. Myers looks forward to helping more patients and collaborating with other surgeons. Patients in Obstetrics and Gynecology, Urology and the Wound Healing Center at MedStar Georgetown have also benefited from ComfortSafe.

Physicians do not encourage ComfortSafe on new patients who have never had a negative experience with standard anesthesia. ComfortSafe is recommended to:

• Patients who have experienced postoperative nausea and vomiting
• Elderly patients who wish to avoid prolonged confusion following anesthesia
• Patients who are at high risk for further reliance on opioids
• Patients who are morbidly obese with obstructive sleep apnea and use CPAP
• Critically ill and oxygen-dependent patients

Dr. Myers has administered anesthesia at MedStar Georgetown for 29 years. His experience helped him sense a bit of fear in Cathy after her last reconstruction surgery.

“I was so afraid of vomiting when I woke up,” said Cathy. “But I think Dr. Myers knew because he didn’t give me much time to think about it. He came right on over to my bed side and confidently said ‘Come on, let’s get up, let’s go’ and, then, he walked me out. I couldn’t believe it. I could really go home and it would be okay!”