Managing Postoperative Pain After Minimally Invasive Gynecologic Surgery in the Era of the Opioid Epidemic.

Abstract

In this review, we examine the evidence behind nonopioid medication alternatives, peripheral nerve blocks, surgical techniques, and postoperative recovery protocols that can help minimize and effectively treat postoperative pain after minimally invasive gynecologic surgery (MIGS). Because of the depth and heterogeneity of the data, a narrative review was performed of reported interventions. A comprehensive review was performed of PubMed, Embase, and the Cochrane Database with a focus on randomized controlled trials. In the absence of literature specific to benign gynecology, similar specialty or procedural data were reviewed. A variety of nonopioid medications, surgical techniques, and postoperative recovery protocols have shown significant improvements in postoperative pain after gynecologic surgery. Nonopioid medication options that are beneficial include acetaminophen, nonsteroidal anti-inflammatories, and antiepileptics. Incision infiltration with local anesthesia also significantly reduces pain. Surgically, minimally invasive approaches, reducing the laparoscopic trocar size to <10 mm, and evacuating the pneumoperitoneum at the end of the case all have significant benefits. Lastly, enhanced recovery pathways show promise in reducing pain after MIGS. By using a multimodal approach, minimally invasive gynecologic surgeons can help to minimize and manage postoperative pain with less reliance on opioid pain medications.

• Authors: Marron Wong, Stephanie Morris, Karen Wang, Khara Simpson
• Journal: Journal of minimally invasive gynecology (J Minim Invasive Gynecol) 2018 Nov - Dec Vol. 25 Issue 7 Pg. 1165-1178 ISSN: 1553-4669 [Electronic] United States
• PMID: 28964926 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2017 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.

Chemical References

• Adrenergic alpha-2 Receptor Agonists
• Analgesics
• Anesthetics, Local
• Anticonvulsants
• Glucocorticoids
• Receptors, N-Methyl-D-Aspartate
• Carbon Dioxide
• Dexamethasone

Topics

• Adrenergic alpha-2 Receptor Agonists (therapeutic use)
• Analgesics (therapeutic use)
• Anesthetics, Local (therapeutic use)
• Anticonvulsants (therapeutic use)
• Carbon Dioxide (administration & dosage)
• Critical Pathways
• Dexamethasone (therapeutic use)
• Equipment Design
• Female
• Glucocorticoids (therapeutic use)
• Gynecologic Surgical Procedures (adverse effects)
• Humans
• Intraoperative Care (methods)
• Laparoscopy (instrumentation, methods)
• Minimally Invasive Surgical Procedures (methods)
• Nerve Block (methods)
• Off-Label Use
• Opioid-Related Disorders (prevention & control)
• Pain, Postoperative (prevention & control, rehabilitation)
• Pneumoperitoneum, Artificial (methods)
• Randomized Controlled Trials as Topic
• Receptors, N-Methyl-D-Aspartate (antagonists & inhibitors)
• Suture Techniques