A Multimodal Pain Pathway in Urogynecologic Surgery

In recent years, there has been an emphasis on the creation of "enhanced-recovery",
"fast-track" or "multi-modal" pathways to improve perioperative care (1-4). The goal of
these programs is to reduce the length of hospital stay, decrease narcotic usage while
improving pain control, accelerate post-operative recovery, and expedite return to baseline
functional status. Pathways often are developed by a team of surgeons, nurses, pain
specialists, anesthesiologists and other support staff. These pathways include preoperative,
intraoperative and postoperative components. Preoperative components involve optimization of
chronic medical conditions prior to surgery, counseling on surgical expectations and
postoperative recovery, limiting preoperative fasting, and cessation of harmful habits
including smoking and alcohol use. Intraoperative components include temperature
maintenance, fluid balance, avoidance of nasogastric tubes, avoidance of unnecessary
peritoneal drains and mechanical bowel preparation, and appropriate analgesia. Postoperative
components often involve multi-modal analgesia, early return to activity and early return to
a regular diet. The goal of this study is to evaluate the efficacy of a multi-modal pain
regimen in the field of Urogynecology.