Perioperative Opioid Requirements in Minimally Invasive Gynecologic Surgery

Study Objective To evaluate postoperative opioid use and the impact of a patient educational intervention regarding the opioid epidemic and proper opioid use/disposal after benign MIGS procedures. Design Prospective Cohort Study Setting Academic hospital center Patients or Participants Adult patients undergoing benign MIGS procedures were enrolled 1/1/2019-1/1/2020. Exclusion criteria: conversion to laparotomy, preoperative opioid use, incapable of written informed consent, non-English speaking. Interventions Educational pamphlets were provided preoperatively. Patients underwent hysterectomy(HYS), myomectomy(MYO), or other laparoscopic(LSC) procedures. Opioid prescriptions were standardized with 25 tablets oxycodone 5mg for HYS/MYO, 10 tablets oxycodone 5mg for LSC (oral morphine equivalents [OME] were maintained for alternative options). Pill diaries were reviewed and patient surveys completed during postoperative visits. Measurements and Main Results Of 106 consented patients, 65(61%) completed their pill diaries (36 HYS, 17 MYO, 12 LSC). Median opioid use was 35 OME for HYS (∼5 oxycodone tablets; IQR 11.25-102.5), 30 OME for MYO (∼4 tablets; IQR 15-75), and 18.75 OME for LSC (∼3 tablets; IQR 7.5-48.75). Median last post-operative day(d) of use was 3d for HYS (IQR 2, 8), 4d for MYO (IQR 1, 7), and 2d for LSC (IQR 0.5-3.5). One patient (MYO) required a refill of 5mg oxycodone (10 tablets). No difference was found between total opioid use and presence of pelvic pain, chronic pain disorders, or psychiatric co-morbidities. Overall satisfaction with pain control (≥4 on a 5-point Likert scale) was 91% for HYS, 100% for MYO, 83% for LSC. Of the 33 patients who read the pamphlet, 32(97%) felt it increased their awareness/knowledge. Conclusion The vast majority of patients required