Reduced Opioid use in Benign, Minimally Invasive Gynecologic Surgery with Eras Protocol - A Resident initiated Quality Improvement Project

Abstract

Study Objective To determine if implantation of an Enhanced Recovery After Surgery (ERAS) protocol would decrease narcotic consumption in postoperative patients following minimally invasive gynecologic surgery. Design Prospective Cohort Setting Sinai Hospital of Baltimore is a community-based teaching hospital. Surgeries included laparoscopic, robotic, and vaginal hysterectomy, robotic sacrocolpopexy, anterior/posterior colporrhaphy, and colpocleisis. All patients in the study were hospitalized for at least one night. Post-operative patients received pain medication based on their pain score, 0-10 (Validated Numeric Rating Scale). Patients or Participants Participants included all patients undergoing benign, minimally invasive, gynecologic surgery at our institution from 01/01/2017- 10/31/018 compared to those after initiation of our intervention on 11/01/2018 (to present). Interventions Preoperative analgesics: Gabapentin 600 mg, Acetaminophen 1 gm, Celebrex 200mg, Scopolamine patch. Postoperative analgesics Acetaminophen 1 gm q6h, Ibuprofen 400-600 mg q6h, Gabapentin 100 mg TID, Lidoderm patch q24h. For moderate pain scores of 4-6, Tramadol 50 mg PO q4h prn. For severe pain score (7+), 5 mg oxycodone PO PRN q6hrs. Measurements and Main Results An unpaired two-tailed T-Test was used to compare the average OMEs administered to patients before the ERAS intervention and after the intervention. There was a statistically significant difference noted (P Value = 0.0015) between the groups. The average OMEs in the pre-intervention group was 42.3 (n = 90) compared to 22.9 (n=48) in the post-intervention group. Conclusion With the implementation an ERAS protocol, the amount of post-operative narcotics was significantly reduced in patients who had undergone minimally invasive gynecologic surgeries. Hospitals providing gynecologic surgery care should adhere to an ERAS protocol to reduce narcotic use in the postoperative patient.