Does Size Matter? Opioid Use after Laparoscopy for Apical Pelvic Organ Prolapse Using an 8 mm versus 10-12 mm Accessory Port.

Abstract

STUDY OBJECTIVE:

To determine whether a change in lateral accessory port (LAP) size from 10-"?>12 mm to 8 mm among women undergoing laparoscopic native tissue pelvic organ prolapse (POP) surgery was effective at reducing opioid use after surgery.

DESIGN:

Prospective cohort of women taking part in a POP surgical registry.

SETTING:

Tertiary academic hospital in Calgary, Canada.

PATIENTS:

Women undergoing laparoscopic uterosacral ligament apical suspensions for stage ≥2 POP with either uterine preservation or concomitant hysterectomy. A total of 92 women were included during a 15-month study period from June 2020 and September 2021.

INTERVENTIONS:

Laparoscopic apical suspension using either a 10-"?>12 mm or 8 mm LAP, with the change occurring at the midpoint of the study period. Fascial defects from 10-"?>12 mm ports were closed with a fascial closure device. Perioperative care and technique were otherwise unchanged.

MEASUREMENTS AND MAIN RESULTS:

Postoperative opioid use was measured by mean morphine equivalent daily dose, accounting for all oral and intravenous opioids used in the first 24 hours after surgery. A total of 50 cases (54.3%) used a 10-12 mm LAP, and 42 cases (45.7%) used an 8 mm LAP. Mean morphine equivalent daily dose after surgery with a 10-12 mm LAP was significantly higher than with an 8 mm LAP (35.3 [95% confidence interval (CI) 24.9-45.6] vs 13.6 [95% CI 8.0-19.2], p <.001). The proportion of women who did not require opioids postoperatively was higher in the 8 mm group (45.2%, n = 19) than the 10-12 mm group (18.0%, n = 9) (crude odds ratio 3.76, 95% CI 1.47-9.66). Similarly, the proportion of women who did not fill an opioid prescription after discharge was higher in the 8 mm group (35.7%, n = 15) than the 10-12 mm group (16.0%, n = 8) (crude odds ratio 2.92, 95% CI 1.09-7.81). These results remained statistically significant after adjustment for age, body mass index, race and ethnicity, length of procedure, and concomitant procedures performed.

CONCLUSION:

Compared with a 10-12 mm port, the use of an 8 mm LAP during laparoscopic native tissue apical POP surgery is associated with decreased opioid use in the first 24 hours after surgery.

• Authors: Allison Edwards, Alison Carter Ramirez, Natalie V Scime, Shunaha Kim-Fine, Erin A Brennand
• Journal: Journal of minimally invasive gynecology (J Minim Invasive Gynecol) Vol. 29 Issue 4 Pg. 528-534 (04 2022) ISSN: 1553-4669 [Electronic] United States
• PMID: 34929399 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 AAGL. Published by Elsevier Inc. All rights reserved.

Chemical References

• Analgesics, Opioid
• Morphine

Topics

• Analgesics, Opioid (therapeutic use)
• Female
• Gynecologic Surgical Procedures (methods)
• Humans
• Laparoscopy (methods)
• Morphine
• Opioid-Related Disorders
• Pelvic Organ Prolapse (surgery)
• Prospective Studies