Optimization of Pre-Operative Oral Analgesics in Patients Undergoing Ambulatory Minimally Invasive Hysterectomy

Abstract

Study Objective To determine the optimal time to administer pre-operative non-opioid oral analgesics to achieve superior post-operative pain modulation in patients undergoing outpatient minimally invasive hysterectomy for benign disease. Design Randomized controlled trial. Setting Minimally invasive gynecologic surgery practice. Patients or Participants Women undergoing benign minimally invasive hysterectomy. Interventions From January 2018 to October 2018, 60 women aged 34-67 years were randomized to treatment (n=30) and control (n=30). Patients in the treatment arm self-administered oral celecoxib, gabapentin, and acetaminophen 3-4 hours prior to surgery, while those in the control arm received these medications in the pre-anesthesia care unit. All patients were administered intravenous nausea and vomiting prophylaxis. Time of oral medication ingestion and orogastric tube placement were collected. Post-operatively, patients were administered intravenous ketorolac and pain scores were assessed on an eleven-point numeric rating scale. Pain medications and anti-emetics were administered as needed prior to discharge. Opioid consumption was collected and converted to oral morphine equivalents (OME). Patients were sent an electronic survey assessing patient satisfaction and surgical recovery score on post-operative day 10. Measurements and Main Results 53 subjects (29 in treatment and 24 in control) were included in the study. Baseline characteristics were balanced between treatment and control arms, with the exception of pre-existing gastro-esophageal reflux which was higher in the treatment group (20.7% vs. 0.0%, p=.026). 24.1% of the treatment arm required OME >50 compared to 41.7% of the control group (p=.174). There were no significant differences in pain score at discharge (p=.234), patient satisfaction (p=.90), or surgical recovery score (p=.189). Conclusion Advanced administration of pre-operative oral analgesia trended towards a decrease in immediate post-operative opioid use when compared to immediate pre-operative administration. Timing of administration had no impact on pain scores, patient satisfaction, or surgical recovery scores. Either technique of administration of pre-operative oral analgesia is acceptable.