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Opioid Use After Laparoscopic Hysterectomy

Am J Obstet Gynecol; ePub 2018 Oct 25; Wong, et al

In a cohort of women undergoing laparoscopic hysterectomy, surgeons prescribed 4 times the number of opioids than was needed for acute postoperative pain control. This according to a prospective survey-based study that included 125 women undergoing laparoscopic hysterectomy for benign indications at 2 community teaching hospitals. Patients were preoperatively surveyed about demographics, past medical history, current and expected pain scores, and were screened for anxiety, depression, and pain catastrophizing. At 1 and 2 weeks after surgery, patients were surveyed about their pain and pain medication use. Researchers found:

  • 98% of patients were prescribed an opioid for acute postoperative pain.
  • The median opioid prescription was for 150 morphine milligram equivalents (MME), equivalent to 20 tablets of oxycodone 5 mg, while median patient postoperative use was 37.5 MME, equivalent to 5 tablets of oxycodone 5 mg.
  • 90% of patients had leftover opioids at 2 weeks after surgery.
  • Preoperative factors most strongly associated with postoperative opioid use included a history of chronic pelvic pain or endometriosis, preoperative opioid use, anxiety, depression, pain catastrophizing, preoperative pain score, anticipated postoperative pain score, and anticipated postoperative pain medication needs.
  • A predictive calculator identified patients who are likely to be high opioid or low opioids users.

Citation:

Opioid use after laparoscopic hysterectomy: Prescriptions, patient use, and a predictive calculator. [Published online ahead of print October 25, 2018]. Am J Obstet Gynecol. doi:10.1016/j.ajog.2018.10.022.