Opioid use following laparoscopic surgery for endometriosis and chronic pelvic pain

Abstract

To measure postoperative opioid use following laparoscopic surgery for endometriosis and chronic pelvic pain (CPP) and identify patient characteristics associated with greater postoperative opioid medication requirements. This was a prospective, survey-based study of 100 women undergoing laparoscopic surgery for endometriosis or CPP by fellowship-trained, minimally invasive gynecologic surgeons at a tertiary care academic center. Following consent, patients completed a preoperative survey inquiring about current pain, anticipated postoperative pain, and recent pain medication use. Subjects completed seven surveys within 30 days postoperatively regarding the quantity and type of pain medication used and current pain levels. Baseline demographics, medical history, and perioperative care details were abstracted from the medical records. Descriptive statistics were calculated for opioid pill usage. Bivariate analyses were performed to compare opioid use at postoperative day 28 across patient and surgical characteristics via Wilcoxon rank sum tests. 100 patients were recruited, and 8 patients were excluded for receiving additional narcotics from outside sources, for a final sample size of 92 patients. All patients responded to the pre-operative survey with postoperative survey response rates ranging from 72% (days 4, 14, and 28) to 80% (day 3). The average number of pain pills prescribed to patients was 10.5, with a minimum of 4 pills (n=1) and maximum of 20 (n=4). Patients reported a cumulative 277.5 opioid pills remaining at the day 28 survey, with a mean of 4.3. 34% (n=22) of patients had no pills left, and 35% (n=23) had at least 7 pills remaining. The mean number of pills taken by day 1 was 1.8, by day 2 was 3.1, by day 3 was 4.5, by day 4 was 4.7, by day 7 was 6.7, and by day 28 was 6.8 (Figure 1). There was a trend of greater opioid use in patients with preoperative diagnoses of CPP and mood disorders (7.93 vs. 5.96; p=0.079; 7.79 vs. 5.25; p=0.19). Undergoing a hysterectomy was associated with a significant increase in postoperative narcotic use (9.66 vs. 5.59; p=0.018). There were no statistical differences in number of pills taken by preoperative pain score categories, longer operative time, presence of deep endometriosis, or pathology confirmed endometriosis (all p> 0.37). Most patients undergoing laparoscopic surgery for endometriosis and CPP had a lower postoperative opioid requirement than prescribed. Average opioid use in our cohort is similar to trends reported for minimally invasive surgery for non-chronic pain indications, suggesting surgeons do not need to prescribe more postoperative narcotics for a majority of pelvic pain patients. Patients with long-standing CPP syndrome or mood disorders may represent a population requiring additional postoperative opioid requirements. Larger multi-center trials are needed to better characterize trends in this population.