Comparing Postoperative Pain With Laparoscopic Versus Robotic Sacrocolpopexy

Abstract

Study ObjectiveTo compare postoperative pain and pain-related outcomes following laparoscopic (LS-MISC) versus robotic minimally invasive sacrocolpopexy (R-MISC). DesignA secondary analysis of an original placebo-controlled randomized-controlled trial (RCT) examining preoperative IV acetaminophen on postoperative pain following MISC. SettingPlanned secondary analysis of multicenter RCT. Patients or ParticipantsWomen undergoing MISC. InterventionsCo-primary outcomes at 24 hours were total opioid use in morphine mg equivalents (MME) and visual analog scale (VAS) pain scores comparing LS-MISC and R-MISC. The secondary outcome was pain scores using a pain diary through seven days post-procedure. Measurements and Main ResultsThe original study was a double blind, multi-center, RCT comparing intravenous acetaminophen to placebo that took place between 2014 and 2017. Given that the original trial was unable to show an impact from the use of intravenous acetaminophen, our analysis focused on the impact of surgical modality. We included 90 subjects undergoing MISC: 65 LS-MISC and 25 R-MISC. Most were Caucasian (97.8%) and postmenopausal (88.9%) with mean age 61.2±7.2 years and BMI 27.6±4.4 kg/m2. IV acetaminophen did not impact pain in the original study and was not different between LS-MISC and R-MISC. Concomitant hysterectomy was performed in 67% (LS-MISC) vs. 60% (R-MISC, p=0.49). LS-MISC underwent more perineorrhaphies (15.4% vs 0%, p=0.04) and posterior repairs (18.5% vs 0%, p=0.02). Operative time was longer with LS-MISC (208.5±57.3 vs 143.6±21.0 minutes, p=<0.01). Length of stay was longer with LS-MISC (0.9±0.4 vs 0.7±0.4 days, p=0.02). Women undergoing LS-MISC consumed more opioid MMEs through 24 hours when including intraoperative opioid's (48.5±25.5 vs 35.1±14.6 MME, p=<0.01). Using linear regression correcting for operative time and concomitant vaginal repairs, this difference disappeared. Likewise, when intraoperative opioids were excluded, there was no difference. There were no differences in 24-hour post-operative VAS scores, opioid use in first week, or quality of life (PROMIS PI-SF, all p<0.05). ConclusionWhen comparing VAS pain scores, MME opioid usage, and quality of life between LS-MISC and R-MISC, there was either no difference or differences disappeared after adjusting for confounders. Overall, opioid use, pain scores, and opioid side effects were low.