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Perioperative use of pain medications in vaginal versus laparoscopic pelvic organ prolapse surgery

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Abstract

Introduction and hypothesis

There has been renewed interest in the management of postoperative pain after benign gynecological surgery. The purpose of the study was to determine if the use of intraoperative and immediate postoperative pain medication differs between vaginal and laparoscopic surgery in women with pelvic organ prolapse.

Methods

The study included women who had undergone pelvic organ prolapse repair between 2014 and 2019 in two tertiary care hospitals. We collected demographic data and pain medication used during and after surgery, including opioids, local anesthetics, gabapentin, ketorolac, ibuprofen, and acetaminophen. Data analyses were performed using STATA Version 16.1. A p value <0.05 was considered to indicate statistical significance.

Results

A total of 195 women were included in the study, with 98 in the vaginal and 97 in the laparoscopic group. Intraoperative opioid use in the two groups was similar (25 morphine milligram equivalent [MME], p = 0.34). However, women in the laparoscopic group received significantly more intravenous and local anesthesia (lidocaine: 60 vs 40 mg; bupivacaine 49.6 vs 20 ml, p < 0.001). Postoperatively, although women in the vaginal group required almost twice as many narcotics as those in the laparoscopy group (MME = 28 vs 15, p < 0.001), after controlling for confounders in the multivariate analysis, there were no differences in postoperative pain requirements between the two groups. Recovery time had a significant impact on opioid and acetaminophen use (p < 0.05).

Conclusion

Use of pain medication was similar in the intraoperative and immediate postoperative period after pelvic organ prolapse surgery when comparing the vaginal and laparoscopic approaches after controlling for potential confounding factors.

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Authors and Affiliations

  1. Division of Urogynecology, Department of Obstetrics and Gynecology, Mass General Brigham Hospital, 75 Francis street, Boston, MA, 02115, USA

    Iwona Gabriel, Talar Abdalian & Vatche A. Minassian

  2. Department of Gynecology, Obstetrics and Oncological Gynecology, Medical University of Silesia, Bytom, Poland

    Iwona Gabriel

Authors
  1. Iwona Gabriel
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  2. Talar Abdalian
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  3. Vatche A. Minassian
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Contributions

Iwona Gabriel: data collection, manuscript writing; Talar Abdalian: data collection, statistical analysis; Vatche Minassian: study protocol preparation, manuscript writing.

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Correspondence to Vatche A. Minassian.

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Gabriel, I., Abdalian, T. & Minassian, V.A. Perioperative use of pain medications in vaginal versus laparoscopic pelvic organ prolapse surgery. Int Urogynecol J 33, 2455–2461 (2022). https://doi.org/10.1007/s00192-021-05068-3

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  • DOI: https://doi.org/10.1007/s00192-021-05068-3

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