42 Increased narcotic requirements after laparoscopic hysterectomy in patients with history of multiple cesarean deliveries

Abstract

Complicated laparoscopic hysterectomies may result in increased manipulation of tissue, and potentially lead to suboptimal postoperative pain control. Given that pain in the post-anesthesia care unit (PACU) has been found to be directly associated with overall patient satisfaction, being able to identify what patients are at higher risk for increased pain would allow for preemptive targeted multimodal interventions to reduce postoperative discomfort. One of the most common factors that increases surgical complexity during hysterectomy is history of cesarean deliveries. The objective of this study was to determine if an increased number of prior cesarean deliveries in patients undergoing a laparoscopic hysterectomy resulted in higher narcotic use in the PACU. A retrospective chart review was performed using cases from 4 fellowship trained MIS surgeons with similar operative techniques. Cases from 2018-2020 were reviewed. We included all patients between the ages of 18 and 60 who underwent laparoscopic hysterectomy and received a preoperative para-cervical block. Patients who had concomitant procedures such as pelvic floor repair, interventions for urinary incontinence, or excision of endometriosis were excluded. Data collected included age, body mass index, uterine weight, estimated blood loss, operative time, and total narcotics received in the PACU. Units of narcotics administered were converted to intravenous morphine milligram equivalents (MMEs) based on the American Pain Society guidelines and critical review papers. T-student was used to compare means between groups. There were 77 patients were selected for analysis. Patients were separated into groups depending on whether they had less than 3 (n = 60) or 3 or more (n = 17) cesarean deliveries. There was no difference regarding age (44.16 vs 44.65, P =.78), BMI (33.68 vs. 34.78, P=.53), EBL (65.17 mL vs. 85.88 mL, P=.14), or uterine weight (212.13 g vs. 202.88 g, P=.78). As expected, operating time was higher in the patients with 3 or more cesareans (140.08 min vs. 180.56 min, P<.01). Total narcotic use in the PACU was also significantly higher this group (5.42 MME vs. 10.24 MME, P<.01). These findings suggest that patients undergoing a laparoscopic hysterectomy with history of 3 or more cesarean deliveries are at a risk for higher narcotic requirements in the PACU and are potential targets for further postoperative pain reduction strategies.