Eliminating Opioid Use After Mini-Laparoscopic Gynecologic Surgery: Effectiveness of a Multimodal Pain Management Approach Adopted into Clinical Practice.

Abstract

Video Objective The objective of this video is to identify an effective, non-opioid, multimodal pain medication regimen, in women undergoing mini-laparoscopic gynecologic surgery, defined in this study as using laparoscopic instrument ports with an inner diameter of ≤5 mm. Setting A 1 year quality improvement, single-institution study was conducted on consecutive patients undergoing laparoscopic gynecologic surgery procedures, using 3 laparoscopic instrument ports with an inner diameter measuring 5 mm or less. Interventions A multimodal pain medication regimen was given in the perioperative period, consisting of one oral dose of gabapentin 300 mg the evening prior to surgery. Oral Acetaminophen 1000 mg and a second dose of oral gabapentin 300 mg given the morning of surgery. Intraoperative infiltration of local Ropivacaine was administered at the incision sites. Postoperatively, patients were started on around-the-clock oral gabapentin 300 mg every 12 hours, acetaminophen 500 mg every 6 hours, and ketorolac 30 mg IV for 3 doses, followed by celecoxib 200 mg every 12 hours. Hospitalization records were reviewed, measuring the number of opioid doses given to these patients on the day of surgery after transfer from the post-anesthesia care unit (PACU), on postoperative day 1, and after discharge. The primary comparative outcome was the number of opioid doses the patient received during each phase of the observation period. Conclusion When combined with reduced (≤ 5mm) diameter laparoscopic instrumentation, a non-opioid, multimodal pain medication regimen, consisting of ropivacaine local anesthesia, and an around-the-clock oral regimen consisting of acetaminophen, NSAIDS, and gabapentin is able to effectively eliminate the need for postoperative opioid use in patients undergoing laparoscopic gynecologic surgery. The objective of this video is to identify an effective, non-opioid, multimodal pain medication regimen, in women undergoing mini-laparoscopic gynecologic surgery, defined in this study as using laparoscopic instrument ports with an inner diameter of ≤5 mm. A 1 year quality improvement, single-institution study was conducted on consecutive patients undergoing laparoscopic gynecologic surgery procedures, using 3 laparoscopic instrument ports with an inner diameter measuring 5 mm or less. A multimodal pain medication regimen was given in the perioperative period, consisting of one oral dose of gabapentin 300 mg the evening prior to surgery. Oral Acetaminophen 1000 mg and a second dose of oral gabapentin 300 mg given the morning of surgery. Intraoperative infiltration of local Ropivacaine was administered at the incision sites. Postoperatively, patients were started on around-the-clock oral gabapentin 300 mg every 12 hours, acetaminophen 500 mg every 6 hours, and ketorolac 30 mg IV for 3 doses, followed by celecoxib 200 mg every 12 hours. Hospitalization records were reviewed, measuring the number of opioid doses given to these patients on the day of surgery after transfer from the post-anesthesia care unit (PACU), on postoperative day 1, and after discharge. The primary comparative outcome was the number of opioid doses the patient received during each phase of the observation period. When combined with reduced (≤ 5mm) diameter laparoscopic instrumentation, a non-opioid, multimodal pain medication regimen, consisting of ropivacaine local anesthesia, and an around-the-clock oral regimen consisting of acetaminophen, NSAIDS, and gabapentin is able to effectively eliminate the need for postoperative opioid use in patients undergoing laparoscopic gynecologic surgery.