Perioperative Pain Control Reduces Need for Postoperative Narcotics After Hysterectomy for Uterine Cancer

Patients receiving perioperative pain control with acetaminophen plus LB demonstrated lower narcotic use in the postanesthesia care unit.
Patients receiving perioperative pain control with acetaminophen plus LB demonstrated lower narcotic use in the postanesthesia care unit.

Preoperative intravenous acetaminophen plus local infiltration of liposomal bupivacaine (LB) during hysterectomy and surgical staging of uterine cancer may reduce the need for postoperative narcotics, according to a retrospective study presented at the 48th Annual Meeting of the Society of Gynecologic Oncology. The purpose of this study was to determine if preoperative acetaminophen and LB improved postoperative pain control and reduced the need for narcotics after hysterectomy and surgical staging for uterine malignancy.1

This single-center retrospective analysis reviewed data from 243 women undergoing robotic hysterectomy and uterine malignancy staging between 2012 and 2016.

Among the cohort, 111 patients received preoperative intravenous acetaminophen (1 g) and local infiltration of LB at the time of port-site closure and 104 patients received no adjunctive pain control. Patient characteristics, including pain scores, age, body mass index, presence of chronic pain syndromes, smoking, and narcotic use within the year prior to surgery were similar between the 2 groups.

Patients who received perioperative pain control with acetaminophen and LB demonstrated significantly lower use of narcotics in the postanesthesia care unit (P =.012) and inpatient (P =.014) settings. Perioperative pain control also decreased the time to discharge by 2.4 hours (P <.005) and reduced the number of postoperative narcotic prescriptions (P =.009).

Patient-reported pain scores were not affected by perioperative acetaminophen and LB use.

The results of this study suggest that although preoperative acetaminophen and local LB did not decrease patient-reported measures of pain, it may reduce the need for postoperative narcotics.

Reference

1. Schwirian K, Connor RS, Kimball KJ, et al. Liposomal bupivacaine and preoperative acetaminophen: useful in minimally invasive surgery too? Presented at: 48th Annual Meeting of the Society of Gynecologic Oncology; March 12-15, 2017; National Harbor, MD.

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