Postoperative Utilization of Opioids After Midurethral Sling Surgery: A Prospective Clinical Practice Study

Abstract

Importance This study was performed to understand opioid consumption after midurethral sling (MUS) procedures to provide surgeons with guidelines on appropriate prescription regimens. Objective This study aimed to evaluate postdischarge narcotic use (PDNU) after MUS surgery using a restrictive postdischarge opioid regimen. Study Design This prospective clinical practice study included women undergoing MUS surgery from December 2018 to October 2019. Patients were discharged with an electronic prescription for 5 tablets of an oral narcotic. Brief Pain Inventory (BPI) surveys were collected preoperatively. Patients answered questions regarding remaining number of opioid tablets, BPI scores, and patient satisfaction on day 1, week 1 (postoperative week [POW] 1), and 4–6 weeks (POW4–6) postoperatively. Electronic records were reviewed to determine narcotic refills. Primary outcome was PDNU measured in morphine milligram equivalents (MME). Secondary outcomes evaluated refill rate, BPI scores, and patient satisfaction. Standard statistical tests were applied. Results Fifty-six patients were included in the analysis. Total median (interquartile range) PDNU was 12.5 (0–37.5) MME at POW1 and 15.0 (0–37.5) MME at POW4–6, which is approximately equivalent to 2 oxycodone (5 mg) tablets. Eighteen patients (32.1%) took 0 narcotics postdischarge. Brief Pain Inventory scores showed that “worst pain” was highest on postoperative day 1 with a median (interquartile range) score of 6 (4–8). At the POW1 and POW4–6 mark, 94.3% and 92% of patients, respectively, were satisfied or extremely satisfied with their pain control. Seven patients (11.8%) required a refill. Conclusions Most patients undergoing MUS surgery used no more than 2 oxycodone (5 mg) tablets during their 6-week postoperative course, with almost a third not requiring any narcotics. Low pain scores and high patient satisfaction rates were noted.

Randomized Trial on Expectations and Pain Control Advancement in Surgery: The REPAIR Study

“…An Enhanced Recovery After Surgery case series of 113 women who underwent urogynecologic surgery received a median of fifteen 5-mg oxycodone pills; by patient report, median narcotic use was 24 MMEs, equivalent to fewer than four 5-mg oxycodone pills. 11,24 Our study corroborates low opioid consumption for major and minor surgical procedures (equivalent to 2-3.5 pills of 5-mg oxycodone) and further adds to the literature suggesting a role for shared decision making with lower narcotics recommended in urogynecologic surgery.…”

“…Overall opioid consumption was low (median, 3 pills vs 1 pill; P = 0.03), although the reduced narcotic group required more narcotic refills (15% vs 2%, P = 0.01) leading study authors to recommend prescribing 5 – 10 tablets of 5-mg oxycodone after prolapse surgery. An Enhanced Recovery After Surgery case series of 113 women who underwent urogynecologic surgery received a median of fifteen 5-mg oxycodone pills; by patient report, median narcotic use was 24 MMEs, equivalent to fewer than four 5-mg oxycodone pills 11,24 . Our study corroborates low opioid consumption for major and minor surgical procedures (equivalent to 2–3.5 pills of 5-mg oxycodone) and further adds to the literature suggesting a role for shared decision making with lower narcotics recommended in urogynecologic surgery.…”