A Systematic Review of Perioperative Opioid Management for Minimally Invasive Hysterectomy

Abstract

Excessive opioid use and misuse is a pervasive and growing societal problem, and decreasing the surgical contribution to this epidemic represents an opportunity to improve outcomes. Here we describe patterns of opioid prescription, consumption, and persistent use among women undergoing minimally invasive hysterectomy (MIH) for benign indications. We performed a systematic review of English full-text articles addressing opioids and gynecologic surgery using MEDLINE and Cochrane Central Register of Controlled Trials according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Additional studies were identified by examination of references. Studies were restricted to randomized controlled, cohort, and observational studies reporting primary data on opioid consumption, prescribing patterns, or risk of persistent use surrounding MIH for benign indications. A risk of bias assessment was performed. Twenty-one studies reported on the 3 outcomes of interest. Median opioid consumption after MIH ranged from 14 to 74 oral morphine equivalents (OMEs) in the first 24 hours and from 50 to 100 OMEs over the first 2 postoperative weeks. Physicians prescribed 125 to 300 OMEs after MIH. Persistent opioid use was identified in 1.5% of women undergoing MIH. In a population at risk for persistent opioid use, prescription often exceeds patients’ needs. Guidelines for opioid prescribing in the setting of multimodal anesthetic regimens may allow us to lessen our contribution to the opioid epidemic. Further research on patients with chronic pain, patients with chronic opioid use, and the role of patient education is needed.