Optimizing Perioperative Pain Control After Ambulatory Urogynecologic Surgery.

Abstract

The objective of this study was to determine the impact of a multimodal protocol on opiate use and postoperative pain after ambulatory urogynecologic surgery. This was a retrospective cohort study comparing ambulatory urogynecologic surgery patients treated under a standard perioperative pain protocol with those treated under a multimodal perioperative pain protocol. The multimodal protocol consisted of preoperative gabapentin and acetaminophen and postoperative scheduled doses of acetaminophen and nonsteroidal anti-inflammatory drugs. Pain scores were obtained from nursing records and assessed on the Numeric Rating Scale 11 per hospital protocol. All opioid dosages were converted into morphine milligram equivalents using standardized conversion tables. We treated 109 patients under the standard protocol and 112 under the multimodal protocol. Patients had similar baseline characteristics. Overall, a minority of patients (39%) used postoperative opioids; this was similar in the 2 groups (P=0.45). The 2 groups also were similar with regard to the total postoperative morphine milligram equivalents (P=0.35). Postoperatively, patients treated under the standard protocol had higher mean pain scores (2.2 vs 1.4, P=0.002). Patients treated under the standard protocol were also significantly more likely to report postoperative pain (69%) than those treated under the multimodal protocol (52%; P=0.01), and the multimodal protocol was associated with a 25% lower risk of postoperative pain (risk ratio, 0.75; 95% confidence interval, 0.60-0.94) than the standard protocol. Patients infrequently use opiates after ambulatory urogynecologic surgery. The use of a multimodal pain protocol was associated with lower pain scores, and patients in a multimodal pain protocol were more likely to report no pain.