Perioperative Use of Pain Medications in Vaginal Versus Laparoscopic Pelvic Organ Prolapse Surgery

Abstract

<h3>Study Objective</h3> To determine if the use of perioperative pain medications differs between vaginal versus laparoscopic surgery in women with pelvic organ prolapse. <h3>Design</h3> We compared the consumption of various pain medications (opioids, intravenous and local anesthetics, non-steroidals, acetaminophen and gabapentin) between vaginal hysterectomy with uterosacral suspension and laparoscopic supracervical hysterectomy with sacrocolpopexy during intraoperative and immediate postoperative period. <h3>Setting</h3> Tertiary care hospital within the US. <h3>Patients or Participants</h3> Women undergoing surgery for pelvic organ prolapse. <h3>Interventions</h3> Retrospective chart review. <h3>Measurements and Main Results</h3> A total of 195 women who underwent pelvic organ reconstructive surgery were included in the study, with 98 in the vaginal and 97 in the laparoscopic group. Duration of surgery was significantly shorter in the laparoscopy (versus vaginal) group (98 vs. 190 minutes, p<0.001), with less blood loss (30 vs. 100ml, p<0.001), and shorter hospital stay (7.05 vs. 20.8 hours, p<0.001). Intraoperative opioid use was similar between the groups (25 MME, p = 0.34). However, women in the laparoscopy group received significantly more intravenous and local anesthesia than in the vaginal group (lidocaine: 60 vs 40mg; bupivacaine 49.6 vs. 20 ml, respectively, p<0.001). Postoperatively, women in the vaginal group required almost twice as many narcotics as those in the laparoscopy group (MME=28 vs. 15, p<0.001). Postoperatively, the groups did not vary in term of ketorolac, ibuprofen, or gabapentin use. After controlling for covariates, postoperative opioid and acetaminophen use were no longer significantly different between the vaginal and laparoscopic groups; however, recovery time was the most significant confounder accounting for the difference across all types of pain medications used, p<0.001. <h3>Conclusion</h3> Women undergoing prolapse repair regardless of route require similar amount of opioid intraoperatively, but differ in use in the postoperative period. Use of non-opioid pain medication were similar between the groups was comparable.