72 Post-anesthesia narcotic use in obese patients following minimally invasive hysterectomy

Abstract

Adequate pain control in the post-anesthesia care unit (PACU) has been directly associated to overall patient satisfaction. Identifying which patients are at increased risk for elevated narcotic use after surgery would allow for targeted multimodal preemptive interventions to reduce the need for narcotics. The objective of this study was to determine if an elevated body mass index (BMI) in patients undergoing laparoscopic hysterectomy increases narcotic requirements in the PACU. A retrospective chart review of all surgical cases between 2018 and 2020 performed by 4 fellowship trained MIS surgeons with similar operative techniques was completed. We included patients who were between 18 and 60 years of age that had undergone a laparoscopic hysterectomy. Patients who received concomitant procedures such as pelvic floor repair, interventions for urinary incontinence, or excision of endometriosis were excluded. Data collected included age, uterine weight, estimated blood loss, operative time, and narcotics received in the PACU. Total dose of administered narcotics was converted to intravenous morphine milligram equivalents (MME) based on the American Pain Society guidelines and critical review papers. T-Student was used to compare means between groups. One hundred eighty-five patients were included for analysis. Patients were divided into 2 groups depending on whether their BMI was less than 30 kg/m2 (n = 60) or equal to or greater than 30 kg/m2 (n = 125). Statistical analysis revealed that the two groups were similar in regards to age (44.48 vs. 43.58, P = 0.38), operative time (170.5 minutes vs. 177.05 minutes, P = 0.46), EBL (91.92 mL vs. 88.88 mL, P = 0.80), and uterine weight (221.6 g vs. 214.9 g, P = 0.80). Total narcotic use in the PACU was significantly higher in the BMI greater than or equal to 30 kg/m2 group at 6.76 MME (SD=6.98) compared to the BMI less than 30 kg/m2 group at 4.15 MME (SD = 5.22) (P = 0.01). These findings suggest that obese patients undergoing laparoscopic hysterectomy are at a risk for increased narcotic requirements in the PACU and are potential targets for further non-narcotic postoperative pain reduction interventions.