Pain and Opioid Analgesic Use After Otorhinolaryngologic Surgery

Objective To quantify pain and opioid use after otorhinolaryngologic surgery. To determine the effect of patient and surgical factors on primary outcomes. Study Design Prospective cohort. Setting Tertiary academic hospital. Subjects and Methods Patients undergoing elective otorhinolaryngologic surgery were prospectively enrolled. Patients completed demographic surveys and psychometric questionnaires assessing attitudes toward pain and baseline anxiety and depression before surgery. After surgery, patients documented peak pain levels (0-100 mm, visual analog scale) and daily prescription and nonprescription analgesic requirements over a 2-week period. Average daily and cumulative pain and opioid use were calculated and compared among patient cohorts stratified by procedure and preoperative factors. Results A total of 134 patients were enrolled. Total tonsillectomy was associated with significantly higher pain scores and opioid consumption, as compared to all other procedures. There was moderate correlation between average cumulative pain and opioid use. Older patients required significantly fewer doses of opioids. There was no effect of sex, marital status, or education level on postoperative pain or opioid use. Psychometric instrument scores and chronic pain or analgesic use were not associated with significant differences in pain or opioid requirements. Most patients were prescribed substantially more opioids than they actually required. Conclusion Postoperative pain following elective otorhinolaryngologic surgery decreases dramatically within the first week and requires only few days of opioid analgesia, with the exception of tonsillectomy. Almost all patients required fewer than 15 doses of opioids.

Download Full-text

Participants with mild, moderate, or severe pain following total hip arthroplasty. A sub-study of the PANSAID trial on paracetamol and ibuprofen for postoperative pain treatment

Scandinavian Journal of Pain ◽

10.1515/sjpain-2020-0141 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Luma Mahmoud Issa ◽

Kasper Højgaard Thybo ◽

Daniel Hägi-Pedersen ◽

Jørn Wetterslev ◽

Janus Christian Jakobsen ◽

...

Keyword(s):

Postoperative Pain ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Severe Pain ◽

Pain Treatment ◽

Opioid Analgesic ◽

Opioid Use ◽

Mild Pain ◽

Total Hip ◽

Pain Scores

AbstractObjectivesIn this sub-study of the ‘Paracetamol and Ibuprofen in Combination’ (PANSAID) trial, in which participants were randomised to one of four different non-opioids analgesic regimen consisting of paracetamol, ibuprofen, or a combination of the two after planned primary total hip arthroplasty, our aims were to investigate the distribution of participants’ pain (mild, moderate or severe), integrate opioid use and pain to a single score (Silverman Integrated Approach (SIA)-score), and identify preoperative risk factors for severe pain.MethodsWe calculated the proportions of participants with mild (VAS 0–30 mm), moderate (VAS 31–60 mm) or severe (VAS 61–100 mm) pain and the SIA-scores (a sum of rank-based percentage differences from the mean rank in pain scores and opioid use, ranging from −200 to 200%). Using logistic regression with backwards elimination, we investigated the association between severe pain and easily obtainable preoperative patient characteristics.ResultsAmong 556 participants from the modified intention-to-treat population, 33% (95% CI: 26–42) (Group Paracetamol + Ibuprofen (PCM + IBU)), 28% (95% CI: 21–37) (Group Paracetamol (PCM)), 23% (95% CI: 17–31) (Group Ibuprofen (IBU)), and 19% (95% CI: 13–27) (Group Half Strength-Paracetamol + Ibuprofen (HS-PCM + IBU)) experienced mild pain 6 h postoperatively during mobilisation. Median SIA-scores during mobilisation were: Group PCM + IBU: −48% (IQR: −112 to 31), Group PCM: 40% (IQR: −31 to 97), Group IBU: −5% (IQR: −57 to 67), and Group HS-PCM + IBU: 6% (IQR: −70 to 74) (overall difference: p=0.0001). Use of analgesics before surgery was the only covariate associated with severe pain (non-opioid: OR 0.50, 95% CI: 0.29–0.82, weak opioid 0.56, 95% CI: 0.28–1.16, reference no analgesics before surgery, p=0.02).ConclusionsOnly one third of participants using paracetamol and ibuprofen experienced mild pain after total hip arthroplasty and even fewer experienced mild pain using each drug alone as basic non-opioid analgesic treatment. We were not able, in any clinically relevant way, to predict severe postoperative pain. A more extensive postoperative pain regimen than paracetamol, ibuprofen and opioids may be needed for a large proportion of patients having total hip arthroplasty. SIA-scores integrate pain scores and opioid use for the individual patient and may add valuable information in acute pain research.

Download Full-text

Intraoperative opioid and non-opioid administration patterns and early postoperative pain: A single-center retrospective longitudinal study

Journal of Opioid Management ◽

10.5055/jom.2019.0528 ◽

2019 ◽

Vol 15 (5) ◽

pp. 389-405

Author(s):

Gregory Smith, MD ◽

Marcel E. Durieux, MD, PhD ◽

Siny Tsang, PhD ◽

Bhiken I. Naik, MBBCh

Keyword(s):

Postoperative Pain ◽

Elective Surgery ◽

Opioid Analgesic ◽

Oral Morphine ◽

Median Number ◽

Single Center ◽

Opioid Use ◽

Pain Scores ◽

Opioid Administration ◽

Over Time

Objective: Characterize changes in intraoperative opioid and non-opioid administration over time and to evaluate self-reported pain scores in the immediate postoperative period.Design: Single-center retrospective longitudinal study.Setting: Academic medical center.Patients, participants: All patients presenting for surgery between 2011 and 2017 in both an inpatient and outpatient setting.Main outcome measure(s): Determine total intraoperative opioid administration using intravenous oral morphine equivalents standardized to weight and intraoperative non-opioid use. Furthermore, postoperative self-reported pain scores within 2 hours of completion of surgery are reported.Results: A total of 112,167 individual cases were identified from March 2011 to June 2017. There was a sustained and significant reduction in intraoperative mean and median opioid administration [2011: 0.16 ± 0.15 mg/kg and 0.13 (0-4.92) mg/kg vs 2017: 0.09 ± 0.09 mg/kg and 0.07 (0-4.17) mg/kg]. These effects are seen in emergent vs elective surgery, ambulatory vs inpatient, preoperative opioid use vs no preoperative opioid use, and those with and without intraoperative loco-regional procedures. Although median number of intraoperative non-opioid analgesic agents was unchanged over time, average difference in the number of intraoperative non-opioids increased over time. Finally, pain scores decreased over time [2011: mean (standard deviation) and median (range): 5.1 ± 2.62 and 5.4 (0-10) vs 2017: 3.29 ± 3.27 and 3 (0-10)].Conclusion: This study confirms that intraoperative opioid use has decreased over time with increased utilization of non-opioid analgesic adjuncts and a commensurate decrease in immediate postoperative pain.

Download Full-text

Influence of Preemptive Intravenous Ibuprofen on Post-Operative Pain and Opioid Consumption after Laparoscopic Cholecystectomy

QJM ◽

10.1093/qjmed/hcaa039.075 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

R A Hamad ◽

M K Shams ◽

M M Kamal ◽

D M Hissein

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Postoperative Period ◽

Open Cholecystectomy ◽

Developed Countries ◽

Opioid Consumption ◽

Opioid Use ◽

Pain Scores ◽

A Prospective Study ◽

Analgesic Use

Abstract Background cholecystectomy is the most common abdominal surgical procedure in developed countries, and is generally performed laparoscopically. Laparoscopic cholecystectomy is regarded as the gold standard surgical technique for gallstone diseases. This procedure results in less postoperative pain, a better cosmetic outcome, shorter hospitalization faster healing, and earlier mobilization than open cholecystectomy. Aim of the Work the purpose of this study is to investigate the effects of a single preemptive dose of IV ibuprofen on postoperative pain and opioid consumption in patients undergoing laparoscopic cholecystectomy. Patients and Methods this study will be a prospective study on patients who are scheduled for laparoscopic cholecystectomy will be informed about the different components of postoperative pain they would experience, and they will be selected by the same investigator for their ability to differentiate these pain components and to use the visual analog scale. After approval of the local ethics committee. Results this study showed that a single preemptive dose of IV ibuprofen reduced 24-hour opioid consumption and was effective in the emergence of lower pain scores in the postoperative period. In addition, IV ibuprofen significantly reduced rescue analgesic use. In addition IV ibuprofen has played a key role with opioid sparing effect. Conclusion a single preemptive dose of 400 mg resulted in better pain scores by reducing postoperative opioid use in the 1st 24 hours in patients undergoing laparoscopic cholecystectomy by 45%. It also reduced rescue analgesic use in the postoperative period and opioid-related side-effects such as nausea-vomiting.

Download Full-text

Psychological interventions to reduce postoperative pain and opioid consumption: a narrative review of literature

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-102434 ◽

2021 ◽

pp. rapm-2020-102434

Author(s):

Kevin Gorsky ◽

Nick D Black ◽

Ayan Niazi ◽

Aparna Saripella ◽

Marina Englesakis ◽

...

Keyword(s):

Postoperative Pain ◽

Postoperative Period ◽

Opioid Consumption ◽

Psychological Interventions ◽

Cochrane Central Register ◽

Relaxation Techniques ◽

Behavioral Modification ◽

Opioid Use ◽

Pain Scores ◽

Study Results

BackgroundEvidence suggests that over half of patients undergoing surgical procedures suffer from poorly controlled postoperative pain. In the context of an opioid epidemic, novel strategies for ameliorating postoperative pain and reducing opioid consumption are essential. Psychological interventions defined as strategies targeted towards reducing stress, anxiety, negative emotions and depression via education, therapy, behavioral modification and relaxation techniques are an emerging approach towards these endpoints.ObjectiveThis review explores the efficacy of psychological interventions for reducing postoperative pain and opioid use in the acute postoperative period.Evidence reviewAn extensive literature search was conducted in MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Medline In-Process/ePubs, Embase, Ovid Emcare Nursing, and PsycINFO, Web of Science (Clarivate), PubMed-NOT-Medline (NLM), CINAHL and ERIC, and two trials registries, ClinicalTrials.Gov (NIH) and WHO ICTRP. Included studies were limited to those investigating adult human subjects, and those published in English.FindingsThree distinct forms of psychological interventions were identified: relaxation, psychoeducation and behavioral modification therapy. Study results showed a reduction in both postoperative opioid use and pain scores (n=5), reduction in postoperative opioid use (n=3), reduction in postoperative pain (n=5), no significant reduction in pain or opioid use (n=7), increase in postoperative opioid use (n=1) and an increase in postoperative pain (n=1).ConclusionSome preoperative psychological interventions can reduce pain scores and opioid consumption in the acute postoperative period; however, there is a clear need to strengthen the evidence for these interventions. The optimal technique, strategies, timing and interface requires further investigation.

Download Full-text

Postoperative Pain and Opioid Use Following Surgical Treatment of Ankle Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00339 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0033

Author(s):

Matthew Pate ◽

Jacob Hall ◽

John Anderson ◽

Donald Bohay ◽

John Maskill ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Ankle Fracture ◽

Management Practices ◽

Opioid Analgesic ◽

The United States ◽

Ankle Fractures ◽

Opioid Use ◽

Opioid Prescription ◽

Opioid Medication

Category: Ankle, Bunion, Trauma Introduction/Purpose: Chronic opioid abuse is one of the greatest public health challenges in the United States. The most common first exposure to opioids comes from acute care prescriptions, such as those after surgery. Moreover, opioids are often prescribed excessively, with current estimates suggesting ˜75% of the pills prescribed are unused. Ankle fractures are the most common operatively treated fracture in orthopaedic surgery, and management of acute pain following surgery is challenging. The optimal perioperative pain regimen is still a point of controversy, as there is limited data available regarding appropriate amount of opioid to prescribe. This study evaluates opioid prescribing techniques of multiple foot and ankle surgeons, and associated patient outcomes. We aim to help surgeons improve their pain management practices and to limit opioid overprescription. Methods: Chart review and phone survey were performed on forty two adult patients within three to six months of ankle fracture fixation at our institution. These patients were offered to voluntarily participate in a standardized questionnaire regarding pain scores, opioid use, non-opioid analgesic use, pain management satisfaction, and patient prescription education. Results: 57% of patients reported that they were given “more” or ”much more” opioid medication than needed, 38% stated that they were given the “right amount”, and 5% reported that they were given ”less” or “much less” than needed. 40.0% were on opioids prior to operation. 53.5% did not require refill of discharge opioid prescriptions, 30.2% of patients did not fill any posteroperative opioid prescription. 16.3% of patients filled their discharge prescription and at least one additionall refill (mean refill = 2.22). Mean number of reported opioid pills taken after surgery was 17.4. Mean satisfaction with overall pain management at phone follow up was 8.6/10. Conclusion: While postoperative pain and management vary substantially, a majority of patients feel that they are given more opioid medication than necessary following ankle fracture repair, and a majority of opioid prescriptions are not completely used. Going forward, it is likely that a majority of patients could experience the same beneficial results with less prescription opioid pain medication, which would reduce overpresciption and potential misuse.

Download Full-text

Postoperative Tourniquet Pain in Patients Undergoing Foot and Ankle Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00423 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0042

Author(s):

Ashish Shah ◽

Eva Lehtonen ◽

Samuel Huntley ◽

Harshadkumar Patel ◽

John Johnson ◽

...

Keyword(s):

Blood Pressure ◽

Postoperative Pain ◽

Length Of Stay ◽

Systolic Blood Pressure ◽

Foot And Ankle ◽

Opioid Use ◽

Tourniquet Time ◽

Pain Scores ◽

Regional Nerve Block ◽

Ankle Surgery

Category: Other Introduction/Purpose: The tourniquet is commonly used in orthopedic surgeries on the upper and lower extremities to reduce blood loss, improve visualization, and expedite the surgical procedure. However, tourniquets have been associated with multiple local and systemic complications, including postoperative pain. Guidelines vary regarding ideal tourniquet pressure and duration, while the practice of fixed, high tourniquet pressures remains common. The relationship between tourniquet pressure, duration, and postoperative pain has been studied in various orthopaedic procedures, but these relationships remain unknown in foot and ankle surgery. The purpose of this study was to assess for correlation between excessive tourniquet pressure and duration and the increased incidence of tourniquet pain in foot and ankle surgery patients. Methods: Retrospective chart review was performed for 132 adult patients who underwent foot and ankle surgery with concomitant use of intraoperative tourniquet at a single institution between August and December of 2015. Patients with history of daily opioid use of 30 or more morphine oral equivalents for greater than 30 days, patients who underwent foot and ankle surgery without regional nerve block, patients deemed to have failed regional nerve block, and patients who underwent foot and ankle surgery without tourniquet use were excluded. Patient’s baseline systolic blood pressure, tourniquet pressure and duration, tourniquet deflation time, tourniquet reinflation pressure and duration, intraoperative blood pressure and heart rate changes, intra-operative opioid consumption, PACU pain scores, PACU opioid consumption, and PACU length of stay were collected. Statistical correlation between tourniquet pressure and duration and postoperative pain scores, pain location, narcotic use, and length of stay in PACU was assessed using linear regression in SPSS. Results: Average age of patients was 47.6 years (Range: 16 - 79). Tourniquet pressure was 280 mmHg in 90.6% of patients (Range: 250-300 mmHg). Only 3.8% percent of patients had tourniquet pressures 100-150 mmHg above systolic blood pressure. Mean tourniquet time was 106.2 ± 40.1 min. Tourniquet time showed significant positive correlation with morphine equivalents used in the perioperative period (N = 121; r = 0.406; p < 0.001). Long tourniquet times (= 90 minutes) were associated with greater intraoperative opioid use than short tourniquet times (= 90 minutes) (19 mg ± 22 mg vs. 5 mg ± 11.6 mg; p <0.001). Tourniquet duration and PACU length of stay had a positive association (R2 = 0.4). Conclusion: The majority of cases of foot and ankle surgery at our institution did not adhere to current tourniquet use guidelines, which recommend tourniquet pressure between 100 and 150 mmHg above patient’s systolic blood pressure. Prolonged tourniquet times at high pressures not based on limb occlusion pressure, as observed in our study, lead to increased pain and opioid use and prolonged time in PACU. Basing tourniquet pressures on limb occlusion pressures could likely improve the safety margin of tourniquets, however randomized studies need to be completed to confirm this.

Download Full-text

Factors Associated with Prescription Opioid Analgesic Use in the US Population, 2011–2014

Pain Medicine ◽

10.1093/pm/pny158 ◽

2018 ◽

Vol 20 (7) ◽

pp. 1338-1346 ◽

Cited By ~ 3

Author(s):

Steven M Frenk ◽

Susan L Lukacs ◽

Qiuping Gu

Keyword(s):

Opioid Analgesic ◽

Opioid Analgesics ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Opioid Use ◽

Factors Associated ◽

The Past ◽

The Us ◽

Opioid Users ◽

Analgesic Use

Abstract Objective This study examined factors associated with prescription opioid analgesic use in the US population using data from a nationally representative sample. It focused on factors previously shown to be associated with opioid use disorder or overdose. Variations in the use of different strength opioid analgesics by demographic subgroup were also examined. Methods Data came from respondents aged 16 years and older who participated in the National Health and Nutrition Examination Survey (2011–2014). Respondents were classified as opioid users if they reported using one or more prescription opioid analgesics in the past 30 days. Results Opioid users reported poorer self-perceived health than those not currently using opioids. Compared with those not using opioids, opioid users were more likely to rate their health as being “fair” or “poor” (40.4% [95% confidence interval {CI} = 34.9%–46.2%] compared with 15.6% [95% CI = 14.3%–17.1%]), experienced more days of pain during the past 30 days (mean = 14.3 [95% CI = 12.9–15.8] days compared with 2.3 [95% CI = 2.0–2.7] days), and had depression (22.5% [95% CI = 17.3%–28.7%] compared with 7.1% [95% CI = 6.2%–8.0%]). Among those who reported using opioids during the past 30 days, 18.8% (95% CI = 14.4%–24.1%) reported using benzodiazepine medication during the same period and 5.2% (95% CI = 3.5%–7.7%) reported using an illicit drug during the past six months. When opioid strength was examined, a smaller percentage of adults aged 60 years and older used stronger-than-morphine opioids compared with adults aged 20–39 and 40–59 years. Conclusions Higher percentages of current opioid users than nonusers reported having many of the factors associated with opioid use disorder and overdose.

Download Full-text

Gabapentin and intrathecal morphine combination therapy results in decreased oral narcotic use and more consistent pain scores after posterior spinal fusion for adolescent idiopathic scoliosis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02525-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Ying Li ◽

Jennylee Swallow ◽

Christopher Robbins ◽

Michelle S. Caird ◽

Aleda Leis ◽

...

Keyword(s):

Physical Therapy ◽

Postoperative Pain ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Intrathecal Morphine ◽

Posterior Spinal Fusion ◽

Trial Registration ◽

Opioid Use ◽

Pain Scores

Abstract Background Gabapentin and intravenous patient-controlled analgesia (PCA) can reduce postoperative pain scores, postoperative opioid use, and time to completing physical therapy compared to PCA alone after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Gabapentin combined with intrathecal morphine has not been studied. The primary purpose of this retrospective study was to evaluate whether perioperative gabapentin and intrathecal morphine provide more effective pain control than intrathecal morphine alone after PSF for AIS. Methods Patients aged 11 to 18 years who underwent PSF for AIS were identified. Patients who received intrathecal morphine only (ITM group) were matched by age and sex to patients who received intrathecal morphine and perioperative gabapentin (ITM+GABA group). The ITM+GABA group received gabapentin preoperatively and for up to 2 days postoperatively. Both groups received oxycodone and the same non-narcotic adjuvant medications. Results Our final study group consisted of 50 patients (25 ITM, 25 ITM+GABA). The ITM+GABA group had significantly lower mean total oxycodone consumption during the hospitalization (0.798 vs 1.036 mg/kg, P<0.015). While the ITM group had a lower mean pain score between midnight and 8 am on POD 1 (2.4 vs 3.7, P=0.026), pain scores were significantly more consistent throughout the postoperative period in ITM+GABA group. The ITM+GABA group experienced less nausea/vomiting (52% vs 84%, P=0.032) and pruritus (44% vs 72%, P=0.045). Time to physical therapy discharge and length of hospital stay were similar. Conclusion Addition of gabapentin resulted in reduced oral opioid consumption and more consistent postoperative pain scores after PSF for AIS. The patients who received intrathecal morphine and gabapentin also experienced a lower rate of nausea/vomiting and pruritus. Trial registration All data was collected retrospectively from chart review, with institutional IRB approval. Trial registration is not applicable.

Download Full-text

Attitudes of surgical nurses toward postoperative opioid use: A qualitative study

Journal of Human Sciences ◽

10.14687/jhs.v17i3.5977 ◽

2020 ◽

Vol 17 (3) ◽

pp. 911-920

Author(s):

Sevim Şen ◽

Esra Usta ◽

Dilek Aygin

Keyword(s):

Nursing Education ◽

Pain Management ◽

Phenomenological Study ◽

Opioid Analgesic ◽

Opioid Use ◽

Face To Face ◽

Surgical Nurses ◽

Opioid Administration ◽

Opioid Drugs ◽

Analgesic Use

Aim: This study was aimed to investigate the attitudes of surgical nurses toward postoperative opioid use. Method: The descriptive phenomenological study consists of 30 surgical nurses in two hospitals in Turkey. Data were collected by semi-structured face to face interviews. Data analyses were done by qualitative theme analysis. Findings: As a result of the theme analysis, six themes related to surgical nurses' attitudes of postoperative opioid analgesic use were identified. These themes are named as follows: primary indications for opioids, safest route for opioid administration, complications observed following opioid administration, opioid addiction, opioid safety, feeling stressed while administrating opioids. Nurses (13/30) stated that intravenous way is safer as it affects fast, and it is easy to control; while 12 nurses said that intramuscular application is safer as there are few possibilities for complications. While all of the nurses were agreed on that opioids are addictive, eighteen of them think that opioid drugs are safe, and 16 stated that administering opioids did not create stress. Conclusions: Nurses face some obstacles related to the use of opioids in the process of pain management, such as the abuse of opioids and encountering side effects. Pain management and opioid use should be given a great place in nursing education.

Download Full-text

Differences in Epidural and Analgesic Use in Patients with Apparent Stage I Endometrial Cancer Treated by Open versus Laparoscopic Surgery: Results from the Randomised LACE Trial

Minimally Invasive Surgery ◽

10.1155/2013/764329 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Jannah Baker ◽

Monika Janda ◽

David Belavy ◽

Andreas Obermair

Keyword(s):

Endometrial Cancer ◽

Early Stage ◽

Randomised Trial ◽

Stage I ◽

Postoperative Phase ◽

Opioid Use ◽

Pain Scores ◽

Epidural Opioid ◽

Analgesic Use ◽

Early Stage Endometrial Cancer

Objectives. We compared postoperative analgesic requirements between women with early stage endometrial cancer treated by total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH).Methods. 760 patients with apparent stage I endometrial cancer were treated in the international, multicentre, prospective randomised trial (LACE) by TAH (n=353) or TLH (n=407) (2005–2010). Epidural, opioid, and nonopioid analgesic requirements were collected until ten months after surgery.Results. Baseline demographics and analgesic use were comparable between treatment arms. TAH patients were more likely to receive epidural analgesia than TLH patients (33% versus 0.5%,P<0.001) during the early postoperative phase. Although opioid use was comparable in the TAH versus TLH groups during postoperative 0–2 days (99.7% versus 98.5%,P=0.09), a significantly higher proportion of TAH patients required opioids 3–5 days (70% versus 22%,P<0.0001), 6–14 days (35% versus 15%,P<0.0001), and 15–60 days (15% versus 9%,P=0.02) after surgery. Mean pain scores were significantly higher in the TAH versus TLH group one (2.48 versus 1.62,P<0.0001) and four weeks (0.89 versus 0.63,P=0.01) following surgery.Conclusion. Treatment of early stage endometrial cancer with TLH is associated with less frequent use of epidural, lower post-operative opioid requirements, and better pain scores than TAH.

Download Full-text