Opioid use following operation for endometriosis or pelvic pain

Postoperative opioid requirement is lower than expected in women with endometriosis or pelvic pain.

Key Points

Highlights:

• The necessity for postoperative opioid use is determined based on the history of surgery for pelvic pain, self-reported chronic pelvic pain syndrome, anxiety, and depression.

Importance:

• Lower doses of opioids should be prescribed following surgery for endometriosis or pelvic pain.

What’s done here?

• This prospective, survey-based study was conducted to assess opioid use in women scheduled for laparoscopic surgery for endometriosis or pelvic pain.
• 92 women who underwent laparoscopy for endometriosis or pelvic pain by the same experienced surgical team were included.
• Patients discharged on the same day were selected as the study population.
• A questionnaire about pain medication use within the previous month, mood disorder diagnoses, and chronic pain syndromes was applied preoperatively.
• The survey evaluating the number of remaining opioid pain pills, other pain medication usage, and current pain level was tested for these women on postoperative days 1, 2, 3, 4, 7, 14, and 28.
• Type, dose, and quantity of opioids used preoperatively and 1 month postoperatively were recorded.

Key results:

• The response rate of the questionnaires was high. Almost half had self-reported chronic pelvic pain syndrome, and 8 patients used opioids within 2 months before the operation. 
• Surgery for chronic pelvic pain was performed previously in 32 patients (34.8%).
• A greater number of pills were prescribed for women undergoing hysterectomies.
• Previous surgery for pelvic pain and diagnoses of self-reported chronic pelvic pain, anxiety, and depression were associated with greater postoperative opioid use.
• The only surgical variable resulting in a significant increase in postoperative opioid use was the "hysterectomy".
• Longer operative time and presence of pathology-confirmed endometriosis had no significant effect on the amount of postoperative opioid use.

Lay Summary

Women with endometriosis have pain in the form of dysmenorrhea, dyspareunia, and chronic pelvic pain, and they have a diminished quality of life depending on the severity of pelvic pain. Opioids have been preferred in many patients suffering from pain, especially during the postoperative period. However, awareness about the overprescription of opioids due to their side-effect profile has recently increased among both clinicians and patients.

Heres et al. from the USA published an original article entitled “Opioid Use After Laparoscopic Surgery for Endometriosis and Pelvic Pain” in the"Journal of Minimally Invasive Gynecology". The authors aimed to evaluate the necessity of postoperative opioid use in women undergoing laparoscopic surgery for endometriosis or pelvic pain.

They applied the survey assessing pain medication use within the previous month and mood disorder diagnoses and chronic pain syndromes preoperatively. In addition, the questionnaire about the number of opioid pills, other pain medication usage, and current pain level on postoperative days 1, 2, 3, 4, 7, 14, and 28 was applied to these women.

There was no significant association between the number of pills prescribed and patients’ characteristics, but a history of surgery for pelvic pain, and diagnoses of self-reported chronic pelvic pain, anxiety, and depression significantly increased postoperative opioid use. The only surgical variable resulting in a significant increase in postoperative opioid use was "undergoing a hysterectomy". Longer operative time and presence of pathology-confirmed endometriosis had no significant effect on the amount of postoperative opioid use.

"In this large minimally invasive gynecologic surgery cohort, patients traditionally thought to be at higher risk of poor postoperative pain control did not need significantly greater numbers of opioids. A continued focus on "institutional enhanced recovery after surgery" protocols, preoperative counseling, and thoughtful prescribing patterns will continue to address minimizing opioid prescribing in pelvic pain patients.", this is the final conclusion of the authors.

Research Source: https://pubmed.ncbi.nlm.nih.gov/36162768/