A comprehensive model for pain management in patients undergoing pelvic reconstructive surgery: a prospective clinical practice study

Ramaseshan, Aparna S.; O’Sullivan, David; Steinberg, Adam C.; Tunitsky-Bitton, Elena

doi:10.1016/j.ajog.2020.05.019

Cited by 26 publications

(53 citation statements)

References 15 publications

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“…In response to rising concerns regarding opioid misuse, there has been a focus on tailoring opioid prescribing for urogynecologic procedures. On average, most studies show that urogynecology patients are prescribed 15–40 opioid tablets after surgery, but only consume 3–13 tablets 6–8 …”

mentioning

confidence: 99%

Opioid Consumption After Urogynecologic Surgery: A Prospective Multicenter Observational Study Using a Text-Messaging Survey Tool

Dahl

McDonald

Brown³

et al. 2022

UROGC

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Importance Understanding postoperative opioid consumption is key to reducing opioid misuse.Objective The aim of the study was to quantify the amount of outpatient opioids consumed after urogynecologic surgery. Study Design This is a prospective multicenter cohort study sponsored by the American Urogynecologic Society Fellow's Pelvic Research Network. Women undergoing pelvic organ prolapse or urinary incontinence surgery between May 2019 and January 2021 were included. Patients used text messaging to report daily opioid consumption, pain levels, and nonopioid analgesic consumption 2 weeks postoperatively. Demographic and perioperative factors associated with high opioid use (>75th percentile) were identified. Results Two hundred sixty-one patients were included from 9 academic centers. The median (interquartile range) morphine milligram equivalents (MME) consumed were 28 (0-65) and prescribed were 75 (50-113). The median ibuprofen and acetaminophen tablets consumed were 19 (10-34) and 12 (4-26). The median pain level was 2.7 of 10 (1.7-4.4). Factors associated with high MME use (>65 MME) included body mass index greater than 30 ( P < 0.01), chronic pain ( P < 0.01), elevated baseline pain score ( P < 0.01), elevated blood loss ( P < 0.01), longer operating time ( P < 0.01), and southern region ( P < 0.01). High MME consumers more frequently underwent perineorrhaphy ( P = 0.03), although this was not significant on multivariate analysis. Conclusions Urogynecology patients consume a median of 28 MME (3-4 oxycodone 5-mg tablets) after surgery, and surgeons prescribe 3 times this amount (75 MME, 10 oxycodone tablets). In addition, there are several factors that can be used to identify patients who will require greater numbers of opioids. These data may be used to enhance existing prescribing guidelines.

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mentioning

confidence: 99%

Opioid Consumption After Urogynecologic Surgery: A Prospective Multicenter Observational Study Using a Text-Messaging Survey Tool

Dahl

McDonald

Brown³

et al. 2022

UROGC

View full text Add to dashboard Cite

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“…Previous studies evaluating opioid use after implementation of multimodal pain management regimens for pelvic reconstructive surgery report a range of 10.0 to 47.2 morphine milligram equivalents in PACU; these studies included all pelvic reconstructive surgical procedures, however, and were not limited to midurethral sling procedures. 44,45 Given the limited amount of opioids used in our study, we believe they likely had a minimal effect on PUR in our population. Strengths of this study include the sizable cohort, in which all patients were cared for by a high-volume female pelvic medicine and reconstructive surgery board-certified surgeon practice.…”

Section: Discussionmentioning

confidence: 91%

“…In our study, all opioid administrations were via an intravenous or oral route, with the average morphine milligram equivalents used in PACU of 5.0 ± 8.2. Previous studies evaluating opioid use after implementation of multimodal pain management regimens for pelvic reconstructive surgery report a range of 10.0 to 47.2 morphine milligram equivalents in PACU; these studies included all pelvic reconstructive surgical procedures, however, and were not limited to midurethral sling procedures 44,45 . Given the limited amount of opioids used in our study, we believe they likely had a minimal effect on PUR in our population.…”

Section: Discussionmentioning

confidence: 94%

Effects of Preoperative Gabapentin on Clinical Outcomes After Outpatient Midurethral Sling Placement

Welch

Dengler

DiCarlo-Meacham

et al. 2022

Female Pelvic Med Reconstr Surg

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ObjectivesThis study aimed to evaluate transient urinary retention in women undergoing outpatient midurethral sling placement who received preoperative gabapentin (treated) versus those who did not (untreated). Secondary outcomes included unexpected admission rates, analgesic usage, time to discharge, and pain.MethodsThis was a retrospective cohort study including women who underwent outpatient midurethral sling placement from 2015 to 2019. Exclusion criteria included suprapubic catheter placement, planned overnight admission, abnormal preoperative postvoid residual volume, and prolonged postoperative catheterization. Logistic regression was performed to evaluate gabapentin usage and urinary retention after adjusting for patient characteristics.ResultsThree hundred two women met the inclusion criteria, with 19.5% experiencing urinary retention after midurethral sling placement. Women older than 65 years were more likely to have urinary retention than those aged 18–65 years (29.8% vs 17.6%, P = 0.054). Of treated participants, 26% had urinary retention versus 18% of untreated participants (P = 0.162). Adjusting for age, parity, pain, operative time, blood loss, sling type, analgesic, scopolamine patch, or hemostatic agent use, treated participants had 72% higher odds of urinary retention (adjusted odds ratio, 1.72; 95% confidence interval, 0.88–3.38; P = 0.113). There was no difference in unexpected admission, analgesic usage, time to discharge, or pain between groups.ConclusionsOne of 5 women had urinary retention after outpatient midurethral sling placement. Although no statistically significant difference was found in urinary retention between groups, the odds of urinary retention in the treated group were increased. Because there was no difference in pain, analgesic usage, or time to discharge between groups, investigation regarding gabapentin use for outpatient urogynecologic surgery is needed.

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“…Many concepts have been implemented in the last few years to reduce postoperative opioid needs in gynecologic patients, including a shared decision-making model [14], change in discharge regimes in minimal invasive surgeries [13] and a quality improvement intervention protocol [12]. Systemic approaches to multimodal analgesia have included systemic administration of acetaminophen and anti-inflammatory drugs and gabapentin [31][32][33][34][35][36][37]. Our results regarding the benefits of a paracervical block before vaginal hysterectomy are in line with those of the other SRs [35,38].…”

Section: Main Findingsmentioning

confidence: 99%

Preemptive local analgesia at vaginal hysterectomy: a systematic review

et al. 2021

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Introduction and hypothesis We conducted a systematic review of the effectiveness of local preemptive analgesia for postoperative pain control in women undergoing vaginal hysterectomy. Methods MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews were searched systematically to identify eligible studies published through September 25, 2019. Only randomized controlled trials and systematic reviews addressing local preemptive analgesia compared to placebo at vaginal hysterectomy were considered. Data were extracted by two independent reviewers. Results were compared, and disagreement was resolved by discussion. Forty-seven studies met inclusion criteria for full-text review. Four RCTs, including a total of 197 patients, and two SRs were included in the review. Results Preemptive local analgesia reduced postoperative pain scores up to 6 h and postoperative opioid requirements in the first 24 h after surgery. Conclusion Preemptive local analgesia at vaginal hysterectomy results in less postoperative pain and less postoperative opioid consumption.

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A comprehensive model for pain management in patients undergoing pelvic reconstructive surgery: a prospective clinical practice study

Cited by 26 publications

References 15 publications

Opioid Consumption After Urogynecologic Surgery: A Prospective Multicenter Observational Study Using a Text-Messaging Survey Tool

Opioid Consumption After Urogynecologic Surgery: A Prospective Multicenter Observational Study Using a Text-Messaging Survey Tool

Effects of Preoperative Gabapentin on Clinical Outcomes After Outpatient Midurethral Sling Placement

Preemptive local analgesia at vaginal hysterectomy: a systematic review

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