7547 Opioid-Sparing Versus Standard Postoperative Pain Regimen for Total Laparoscopic Hysterectomy: A Randomized Controlled Trial

Study Objective

This study investigated whether ICE-T, a multimodal opioid-sparing pain regimen using ice packs, acetaminophen (Tylenol), and ketorolac (Toradol) provided effective postoperative pain management compared with a standard pain regimen for total laparoscopic hysterectomy (TLH).

Design

This randomized controlled trial was designed to achieve over 90% power. Patients who underwent TLH were randomized to the ICE-T or standard pain regimen and outcomes were followed until postoperative day 4.

Setting

Intra-operatively patients were in dorsal lithotomy and Trendelenburg position.

Patients or Participants

Patients undergoing TLH for benign indications at the academic center from August 2019 until June 2021 were assessed for eligibility. Sixty-seven patients were enrolled preoperatively; 36 were randomized to the ICE-T regimen and 31 to the standard regimen.

Interventions

The ICE-T regimen prescribed around-the-clock ice-packs, acetaminophen and ketorolac. The standard protocol prescribed as needed ibuprofen and acetaminophen/oxycodone based on pain score. Both regimens included hydromorphone for breakthrough pain. These regimens were used inpatient and outpatient from post-anesthesia care unit discharge onwards.

Measurements and Main Results

Postoperative day 1 and 4 outcomes were evaluated using visual analog scales, validated Quality of Recovery Questionnaires, patient satisfaction scores, inpatient narcotic consumption and outpatient pain medication consumption. Patient and surgical demographics were evenly distributed. The median visual analog score and quality of recovery scores on postoperative day 1 were not significantly different; p=0.44 and p=0.85 respectively. However, the ICE-T arm median narcotic consumption on postoperative day 1 was significantly lower; 480.6 morphine milligram equivalents (MME) versus 619.2 MME, p=0.02. ICE-T arm postoperative day 4 median visual analog scores were also significantly lower in the per-protocol analysis (p=0.014). There were no significant differences in the postoperative day 4 median quality of recovery or satisfaction scores.

Conclusion

The ICE-T regimen is an effective multimodal opioid-sparing postoperative pain regimen for TLH. ICE-T has comparable pain control and patient satisfaction to the standard regimen while significantly decreasing narcotic consumption.