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Reducing Postoperative Opioids After Minimally Invasive Hysterectomy with Enhanced Recovery

Introduction We evaluated the efficacy of various strategies utilized for the control of postoperative pain after minimally invasive hysterectomy. The primary enhanced recovery after surgery (ERAS) protocol of interest utilized premedication (acetaminophen, celecoxib and pregabalin), then intraoperative subcutaneous liposomal bupivacaine followed by scheduled oral acetaminophen and ibuprofen postoperatively. Patients also had tramadol and oxycodone as needed for moderate or severe breakthrough pain, respectively. Materials and Methods We conducted a retrospective cohort study that included all patients who underwent minimally invasive hysterectomy (total laparoscopic hysterectomy and laparoscopic-assisted vaginal hysterectomy) for both benign and oncologic indications over a two-year period. We then compared six protocols; three were ERAS protocols and three were traditional pain control methods. The control group was comprised of the traditional pain control group without intraoperative placement of local analgesia. Patient medical records were evaluated for demographics, surgical characteristics, opioid type and dose, pain scores, length of stay and complications. Opioids were converted to oral morphine dose equivalents.