Optimizing Perioperative Pain Control After Ambulatory Urogynecologic Surgery

Abstract

Objectives The objective of this study was to determine the impact of a multimodal protocol on opiate use and postoperative pain after ambulatory urogynecologic surgery. Methods This was a retrospective cohort study comparing ambulatory urogynecologic surgery patients treated under a standard perioperative pain protocol with those treated under a multimodal perioperative pain protocol. The multimodal protocol consisted of preoperative gabapentin and acetaminophen and postoperative scheduled doses of acetaminophen and nonsteroidal anti-inflammatory drugs. Pain scores were obtained from nursing records and assessed on the Numeric Rating Scale 11 per hospital protocol. All opioid dosages were converted into morphine milligram equivalents using standardized conversion tables. Results We treated 109 patients under the standard protocol and 112 under the multimodal protocol. Patients had similar baseline characteristics. Overall, a minority of patients (39%) used postoperative opioids; this was similar in the 2 groups (P=0.45). The 2 groups also were similar with regard to the total postoperative morphine milligram equivalents (P=0.35). Postoperatively, patients treated under the standard protocol had higher mean pain scores (2.2 vs 1.4, P=0.002). Patients treated under the standard protocol were also significantly more likely to report postoperative pain (69%) than those treated under the multimodal protocol (52%; P=0.01), and the multimodal protocol was associated with a 25% lower risk of postoperative pain (risk ratio, 0.75; 95% confidence interval, 0.60–0.94) than the standard protocol. Conclusions Patients infrequently use opiates after ambulatory urogynecologic surgery. The use of a multimodal pain protocol was associated with lower pain scores, and patients in a multimodal pain protocol were more likely to report no pain.

Effect of Intelligent Medical Management Platform Combined with Perioperative Detailed Nursing on Cognitive Ability, Postoperative Complications, and Quality of Life of Patients Undergoing Hysterectomy

“…The effect of detailed nursing has been demonstrated in patient population with lung cancer, coronary heart disease in the elderly with type 2 diabetes, and other diseases [ 5 , 6 ]. With the advancement of big data era, intelligent medical tools with the advantages of real-time review and long-time preservation are widely used in the clinical management of hospitalized patients and have now been used in patient populations such as those with lumbar degenerative diseases and young and middle-aged hypertension [ 7 , 8 ]. In this study, with the help of an intelligent medical tool, nursing intervention was implemented for patients undergoing hysterectomy throughout the whole process from patient admission to postoperative rehabilitation, in the hope of providing better perioperative nursing services for such patients and then effectively improving prognosis, which is of great significance to improve patients' postoperative QOL and reduce the occurrence of complications.…”

Postoperative Opioid Prescribing After Female Pelvic Medicine and Reconstructive Surgery

“…Multimodal, opioid-sparing pain management is a core component of all ERAS protocols, a strategy that is supported by evidence showing that multimodal pain regimens lower the risk of pain and postoperative pain scores and facilitate same-day discharge after FPMRS procedures without increasing complications. 41,57,58 This approach decreases opioid consumption during hospitalization and after discharge. 17,26 For management of perioperative pain, current recommendations support use of adjunct medications including pregabalin (in place of gabapentin), tricyclic antidepressants, and serotonin/norepinephrine reuptake inhibitors and ketamine.…”

Day-of-Surgery Gabapentinoids and Prolonged Opioid Use: A Retrospective Cohort Study of Medicare Patients Using Electronic Health Records

“…[6][7][8] Likewise, as opioid-sparing techniques gained in popularity, 9,10 hospital protocols increasingly added off-label gabapentinoid use to surgical protocols. [11][12][13] It remains unknown to what extent off-label use of gabapentinoids in perioperative pain management can safely reduce opioid consumption and longterm risks of opioid use in different surgical settings and patient populations. 14 To address this knowledge gap, this study used a large surgical cohort of Medicare patients from an integrated health system to test the hypothesis that preoperative day-of-surgery gabapentinoid administration is associated with reduced prolonged opioid use following major surgical procedures.…”

“…6–8 Likewise, as opioid-sparing techniques gained in popularity, 9,10 hospital protocols increasingly added off-label gabapentinoid use to surgical protocols. 11–13…”