Narcotics Inpatient / Outpatient

Managing pain in postoperative patients presents challenges in striking a balance between
achieving adequate pain control and over-prescribing opioids that have the potential to
contribute to the opioid epidemic. There are no clear guidelines informing postoperative
opioid prescribing in obstetrics and gynecology. A recent study by As-Sanie et al.
demonstrated that gynecologists at a large academic medical center prescribe twice the amount
of opioids than the average patient uses after hysterectomy.1 Similarly, a study completed at
Vanderbilt University Medical Center showed that obstetricians were overprescribing narcotics
to patients after cesarean deliveries.2

In addition to rates of opioid prescribing, other factors affect postoperative opioid
consumption, including individual patient measures of anxiety, depression, and self-reported
pain scores prior to surgery. Preoperative Fibromyalgia symptom scores, STAIT state anxiety
scores and NRS pain expectations are independent predictors for morphine consumption
following hysterectomy.

There is a pressing need to better understand the factors that impact opioid use in women who
undergo gynecologic surgery in order to mitigate the over-use of opioids for pain control
upon discharge from the hospital.

Aims:

1. Understand the factors that impact opioid use for pain management in gynecologic surgery
patients after discharge.

1. Is opioid consumption during the immediate postoperative recovery phase associated
with consumption after discharge?

2. Are variables that are known to be associated with opioid consumption, also
associated with opioid consumption after discharge?

3. Are there factors which we can use to predict opioid consumption in postoperative
patients?

2. Develop a model that incorporates individual patient baseline measures (e.g. anxiety,
fibromyalgia score, inpatient narcotic consumption) to predict the amount of opioids
needed following discharge.

Inclusion Criteria:

- 18 years old or older

- Undergoing vaginal, laparoscopic or robotic gynecologic surgery requiring observation
or inpatient stay overnight

- Agree to receiving contact from research staff for follow up

- Can provide two telephone numbers or a telephone number and email address

Exclusion Criteria:

- Unable to provide informed consent

- Age <18

- Intolerance/allergy to more than two narcotic medications

- Allergy/contraindication to non-steroidal anti-inflammatory drugs (NSAIDs)

- Has a diagnosed gynecologic malignancy other than Grade 1 endometrial cancer

- Pregnant

- Current opioid use on a regular basis (more than twice per week)

- Illicit drug-use within the past 30 days