Opioid Use After Laparoscopic Surgery for Endometriosis and Pelvic Pain

Study Objective: The primary objective was to quantify postoperative opioid use after laparoscopic surgery for endometri-osis or pelvic pain. The secondary objective was to identify patient characteristics associated with greater postoperative opi-oid requirements. Design: Prospective, survey-based study in which subjects completed 1 preoperative and 7 postoperative surveys within 28 days of surgery regarding medication usage and pain control. Setting: Tertiary care, academic center. Patients: A total of 100 women with endometriosis or pelvic pain. Interventions: Laparoscopic same-day discharge surgery by fellowship-trained minimally invasive gynecologists. Measurements and Main Results: A total of 100 patients were recruited and 8 excluded, for a final sample size of 92 patients. All patients completed the preoperative survey. Postoperative response rates ranged from 70.7% to 80%. The mean number of pills (5 mg oxycodone tablets) taken by day 28 was 6.8. The average number of pills prescribed was 10.2, with a minimum of 4 (n = 1) and maximum of 20 (n = 3). Previous laparoscopy for pelvic pain was associated with a signifi-cant increase in postoperative narcotic use (8.2 vs 5.6; p = .044). Hysterectomy was the only surgical procedure associated with a significant increase in postoperative narcotic use (9.7 vs 5.4; p = .013). There were no difference in number of pills taken by presence of deep endometriosis or pathology-confirmed endometriosis (all p >.36). There was a trend of greater opioid use in patients with diagnoses of self-reported chronic pelvic pain, anxiety, and depression (7.9 vs 5.7, p = .051; 7.7 vs 5.2, p = .155; 8.1 vs 5.6, p = .118). Conclusion: Most patients undergoing laparoscopic surgery for endometriosis and pelvic pain had a lower postoperative opioid requirement than prescribed, suggesting surgeons can prescribe fewer postoperative narcotics in this population. Patients with a previous surgery for pelvic pain, self-reported chronic pelvic pain syndrome, anxiety, and depression may represent a subset of patients with increased postoperative opioid requirements. Journal of Minimally Invasive Gynecology (2022) 29, 1344-1351. (c) 2022 AAGL. All rights reserved.