Skip to main content
Log in

Postoperative opioid use for patients with chronic pelvic pain undergoing robotic surgery for resection of endometriosis

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

We aimed to identify the amount of opioids used in the postoperative setting for patients with a history of chronic pelvic pain undergoing robotic surgical excision of endometriosis and compare this to patients undergoing benign robotic gynecologic surgery for other indications. We conducted a retrospective cohort study in an urban academic university hospital from January 2019 to March 2020. Data regarding opioid use was collected via a patient-reported survey that was given at the 3 weeks follow-up visit. Data regarding opioid use was compared to patients undergoing robotic surgery for other benign gynecologic indications. Our study included 158 patients, 119 undergoing surgery for endometriosis and 39 patients undergoing robotic surgery for other benign gynecologic indications. Patients undergoing surgery for endometriosis used on average 105.9 morphine milligram equivalents (MME), equivalent to 14 tabs of oxycodone 5 mg. There was no statistically significant difference in the amount of opioids used postoperatively based on stage of endometriosis or need for hysterectomy. Patients undergoing surgery for other benign indications used on average 49.4 MME, equivalent to 6 tabs of oxycodone 5 mg. The difference in amount of opioids used between patients with and without endometriosis was statistically significant. In conclusion, patients undergoing robotic surgery for endometriosis used over two times as many opioids postoperatively as patients without endometriosis and have a higher perceived postoperative pain. Providers should be aware of this difference in order to provide better pain control for this patient population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Availability of data and material

The data that support the findings of this study are available on request from the corresponding author, XG. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

Code availability

The codes for this study are available on request from the corresponding author, XG. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

References

  1. Practice T, Medicine R (2014) Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril 101(4):927–935. https://doi.org/10.1016/j.fertnstert.2014.02.012

    Article  Google Scholar 

  2. ACOG (2019) PB Chronic Pelvic Pain. Obstet Gynecol 133(76):168–186

    Google Scholar 

  3. Mathias SD, Kuppermann M, Liberman R, Lipschutz R, Steege J (1996) Chronic pelvic pain: prevalence, health-related quality of life and economic correlates. Obstet Gynecol 87(3):321–327

    Article  CAS  Google Scholar 

  4. ACOG (2010) Management of endometriosis. Practice bulletin no.114. American college of obstetricians and gynecologists. Obstet Gynecol 2010(116):223–236

    Google Scholar 

  5. Surgery R, Conditions NG (2004) ACOG committee opinion #297. Obstet Gynecol 104(2):423–424. https://doi.org/10.1097/00006250-200408000-00049

    Article  Google Scholar 

  6. Huang Y, Duan K, Koythong T et al (2021) Application of robotic single-site surgery with optional additional port for endometriosis: a single institution’s experience. J Robot Surg. https://doi.org/10.1007/s11701-021-01217-4

    Article  PubMed  Google Scholar 

  7. Guan X, Nguyen MTA, Walsh TM, Kelly B (2016) Robotic single-site endometriosis resection using firefly technology. J Minim Invasive Gynecol 23(1):10–11. https://doi.org/10.1016/j.jmig.2015.08.001

    Article  PubMed  Google Scholar 

  8. Centers for Disease Control and Prevention (United States) (2021) Drug overdose deaths [internet]. Available at: https://www.cdc.gov/drugoverdose/data/statedeaths.html. Accessed 2 Feb 2021

  9. Volkow ND, Jones EB, Einstein EB, Wargo EM (2019) Prevention and treatment of opioid misuse and addiction: a review. JAMA Psychiat 76(2):208–216. https://doi.org/10.1001/jamapsychiatry.2018.3126

    Article  Google Scholar 

  10. Makary MA, Overton HN, Wang P (2017) Overprescribing is major contributor to opioid crisis. BMJ 359:19–20. https://doi.org/10.1136/bmj.j4792

    Article  Google Scholar 

  11. Hill MV, Mcmahon ML, Stucke RS, Barth RJ (2017) Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg 265(4):709–714. https://doi.org/10.1097/SLA.0000000000001993

    Article  PubMed  Google Scholar 

  12. Madsen AM, Stark LM, Has P, Emerson JB, Schulkin J, Matteson KA (2018) Opioid knowledge and prescribing practices among obstetrician-gynecologists. Obstet Gynecol 131(1):150–157. https://doi.org/10.1097/AOG.0000000000002407

    Article  PubMed  Google Scholar 

  13. Bengtson J (2009) Womens Health care center for Womens health. Am J Crit Care. https://doi.org/10.4037/ajcc2011673

    Article  Google Scholar 

  14. Wong M, Vogell A, Wright K, Isaacson K, Loring M, Morris S (2019) Opioid use after laparoscopic hysterectomy: prescriptions, patient use, and a predictive calculator. Am J Obstet Gynecol 220(3):259.e1-259.e11. https://doi.org/10.1016/j.ajog.2018.10.022

    Article  Google Scholar 

  15. Patanwala I, Ouyang C, Fisk M, Lamvu G (2020) Opioid prescription usage after benign gynecologic surgery: a prospective cohort study. J Minim Invasive Gynecol 27(4):860–867. https://doi.org/10.1016/j.jmig.2019.07.007

    Article  PubMed  Google Scholar 

  16. Lovich-Sapola J, Smith CE, Brandt CP (2015) Postoperative pain control. Surg Clin N Am 95(2):301–318. https://doi.org/10.1016/j.suc.2014.10.002

    Article  PubMed  Google Scholar 

  17. Centers for Disease Control and Prevention (United States) (2017) Calculating total daily dose of opioids for safer dosage [internet]. Available at: http://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf. Accessed 14 Jan 2021

  18. Griffith KC, Clark NV, Zuckerman AL, Ferzandi TR, Wright KN (2018) Opioid prescription and patient use after gynecologic procedures: a survey of patients and providers. J Minim Invasive Gynecol 25(4):684–688. https://doi.org/10.1016/j.jmig.2017.11.005

    Article  PubMed  Google Scholar 

  19. As-Sanie S, Till SR, Mowers EL et al (2017) Opioid prescribing patterns, patient use, and postoperative pain after hysterectomy for benign indications. Obstet Gynecol 130(6):1261–1268. https://doi.org/10.1097/AOG.0000000000002344

    Article  PubMed  PubMed Central  Google Scholar 

  20. Carvalho B, Zheng M, Harter S, Sultan P (2016) A prospective cohort study evaluating the ability of anticipated pain, perceived analgesic needs, and psychological traits to predict pain and analgesic usage following cesarean delivery. Anesthesiol Res Pract. https://doi.org/10.1155/2016/7948412

    Article  PubMed  PubMed Central  Google Scholar 

  21. Vercellini P, Trespidi L, De Giorgi O, Cortesi I, Parazzini F, Crosignani PG (1996) Endometriosis and pelvic pain: relation to disease stage and localization. Fertil Steril 65(2):299–304. https://doi.org/10.1016/s0015-0282(16)58089-3

    Article  CAS  PubMed  Google Scholar 

  22. Parazzini F, Cipriani S, Moroni S et al (2001) Relationship between stage, site and morphological characteristics of pelvic endometriosis and pain. Hum Reprod 16(12):2668–2671. https://doi.org/10.1093/humrep/16.12.2668

    Article  Google Scholar 

Download references

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

Authors

Contributions

All authors named on this submission made substantial contributions to the study. Material preparation, data collection and analysis were by SD, TK, MT, and XG. HS-H performed all statistical analysis. The first draft of the manuscript was written by SD and all authors commented on previous versions of the manuscript and approved the final manuscript.

Corresponding author

Correspondence to Xiaoming Guan.

Ethics declarations

Conflict of interest

Dr. S Delgado, MD, T Koythong, MD, M Turrentine, MD, H Sangi-Haghpeykar, X Guan, MD declare that they have no financial disclosures or conflicts of interests.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the IRB for Baylor College of Medicine. Approval Date: 3/30/2020. IRB Number: H-47180.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Delgado, S.I., Koythong, T., Turrentine, M.A. et al. Postoperative opioid use for patients with chronic pelvic pain undergoing robotic surgery for resection of endometriosis. J Robotic Surg 16, 421–427 (2022). https://doi.org/10.1007/s11701-021-01259-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-021-01259-8

Keywords

Navigation