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Decreasing postoperative narcotics in reconstructive pelvic surgery: a randomized controlled trial.
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- Author(s): Reagan, Krista M.l.; O'sullivan, David M.; Gannon, Richard; Steinberg, Adam C.
- Source:
American Journal of Obstetrics & Gynecology; Sep2017, Vol. 217 Issue 3, p325.e1-325.e10, 1p- Subject Terms:
POSTOPERATIVE pain; PELVIC surgery; RANDOMIZED controlled trials; ACETAMINOPHEN; PLASTIC surgery; PHYSIOLOGY; MANAGEMENT; POSTOPERATIVE pain prevention; THERAPEUTIC use of narcotics; ANALGESICS; AMINES; GABA; IBUPROFEN; ANTIEMETICS; DRUG therapy; MORPHINE; CARBOCYCLIC acids; DRUG utilization statistics; COMBINATION drug therapy; COMPARATIVE studies; GYNECOLOGIC surgery; RESEARCH methodology; INTRAOPERATIVE care; MEDICAL cooperation; POSTOPERATIVE care; PREANESTHETIC medication; QUESTIONNAIRES; RESEARCH; EVALUATION research; PAIN measurement; BRIEF Pain Inventory; THERAPEUTICS - Source:
- Additional Information
- Abstract:
Background: Postoperative pain control is crucial to any successful recovery plan. Many currently used medication regimens are narcotic-focused.Objective: The objective of our study was to evaluate the efficacy of a multimodal pain regimen after pelvic reconstructive surgery.Study Design: The primary outcome measure was narcotic use. Secondary outcomes included pain, nausea, and constipation. Patients were randomized to either usual care postoperative treatment or multimodal pain regimen. Usual care included no specific preoperative or intraoperative medications, and postoperative narcotics with ibuprofen. Multimodal pain regimen included preoperative and postoperative celecoxib, gabapentin, intraoperative and postoperative intravenous and oral acetaminophen and ibuprofen, and narcotics as needed. All narcotics were converted to milligram equivalents of oral morphine for standardization according to Centers for Disease Control and Prevention guidelines where conversion factors for oral hydrocodone = 1, oral oxycodone = 1.5, and oral hydromorphone = 4. Patients were given the validated Brief Pain Inventory survey preoperatively (baseline), at postoperative day 1, and 1 week postoperatively. At 1 week, bowel function and narcotics usage was assessed.Results: Seventy patients were randomized to the usual care arm and 68 to the multimodal pain regimen arm. Patients in the multimodal pain regimen arm used significantly fewer intravenous narcotics in the operating room (90.7 ± 39.1 mg vs 104.6 ± 33.5 mg; P = .026) and while in the hospital (10.8 ± 15.1 mg vs 31.2 ± 29.6 mg; P < .001) and were more likely to use 0 oral narcotics after discharge to home (34.8% of patients vs 10.6%; P = .001). Of the patients who did use oral narcotics after discharge to home, there was no difference in amount used between groups (121.3 ± 103.7 mg in the multimodal pain regimen arm vs 153.0 ± 113.8 mg in the usual care arm; P = .139). Total narcotic usage (operating room + hospital + home) was significantly less in the multimodal pain regimen arm of the study (195.5 ± 147.2 mg vs 304.0 ± 162.1 mg; P < .001). There were no significant differences in pain scores between the 2 arms of the study on either postoperative time point. There were no significant differences in antiemetic use while in hospital, consistency of first bowel movement, length of stay, or number of telephone calls to nurses in first 3 weeks postoperatively.Conclusion: A multimodal pain regimen in pelvic reconstructive surgery was found to decrease postoperative opioid requirements, while providing equivalent pain control. [ABSTRACT FROM AUTHOR] - Abstract: Copyright of American Journal of Obstetrics & Gynecology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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