2524 Perioperative Non-Opioid Pain Control Adjuncts and Postoperative Opioid Use after Benign Gynecologic Surgery

Abstract

Study Objective To assess associations between perioperative non-opioid pain control adjuncts and postoperative opioid use. Design Survey and retrospective chart review of patients who underwent a minimally invasive hysterectomy or laparoscopic adnexal surgery at a single academic institution between October 2017 and October 2018. Patients underwent a structured telephone interview 5-7 days after discharge and a chart review one month later. The primary outcome was morphine milligram equivalent (MME) use after discharge. Setting N/A Patients or Participants Of 352 patients enrolled, 124 met inclusion and exclusion criteria, including 87 who underwent minimally invasive hysterectomy and 42 laparoscopic adnexal surgery. Ten of these participants did not consent to a medical record review. Interventions The perioperative non-opioid adjuncts examined include preoperative administration of celecoxib, gabapentin, pregabalin, and/or acetaminophen; intraoperative application of bupivacaine topically to the diaphragm; and postoperative ketorolac. Surgeons treated patients at their own discretion. Measurements and Main Results The median MME used after minimally invasive hysterectomy and laparoscopic adnexal surgery was 8 and 8.2 respectively, with 42% of participants not receiving, not filling or not using their opioid prescription at all. The median proportion of MME used to MME prescribed was 10% for hysterectomy and 20% for adnexal surgeries. Of these patients, 33.3% received at least one preoperative medication, 18% had intraoperative bupivacaine, and 71% received postoperative ketorolac. There were no statistically significant differences in MME use between those who did or did not receive any of the perioperative non-opioid adjuncts, though there was a trend toward lower MME use with post-operative ketorolac (6.35 vs 23.4 MME, p 0.056). Conclusion Some patients do not require post-operative opioid medications after a minimally invasive hysterectomy or adnexal surgery and most use only a small fraction of the amount prescribed. Perioperative adjunct therapies did not demonstrate statistically significant reductions in opioid use, though small numbers and lack of standardization limit the evaluation.