Nonnarcotic analgesics may be feasible replacements for narcotics in managing postoperative pain in women who undergo perineal and vaginal reconstructive surgery, according to a study presented here at the 38th Annual Meeting of the American Urogynecologic Society (AUGS).
Although narcotic analgesics are the most commonly administered drugs for pain after perineal and vaginal reconstructive surgery and are known to be effective, they do come with possible side effects, including constipation, urinary retention, and nausea.
Even more problematic, side effects such as constipation can place pressure on the pelvis and adversely affect the surgical repair.
It is “critical to find alternatives to narcotic pain relievers that are still capable of providing adequate pain control,” stated Pooja S. Parameshwar, Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California, and colleagues.
The researchers analysed patients who underwent surgery for genitourinary fistula, rectovaginal fistula, large-grade perineal lacerations, and pelvic organ prolapse (POP) in 2015 and 2016 in a regional hospital in Uganda.
The 64 women in the study underwent a similar postoperative pain management regimen that included the administration of nonnarcotic analgesics, including acetaminophen, diclofenac, and ibuprofen. Patients received diclofenac immediately after surgery and acetaminophen and ibuprofen as needed.
The researchers used the 10-point Wong-Baker FACES scale along with a record-based review of medication requirements to assess pain levels. They found that only 3 patients (4.7%) who underwent fistula surgery experienced postoperative pain that was not relieved by any of the nonnarcotic analgesics alone, and these patients were given meperidine.
Pain scores indicated that the use of nonnarcotic analgesics significantly reduced pain. Patients who had surgery for fistula, perineal laceration, and POP had mean initial pain scores of 3.46, 2.19, and 2.44, respectively. The patients’ final pain scores (after a mean follow-up of 1.75 days) were 2.07, 0.56, and 1.62, respectively.
In addition, all patients indicated decreased pain scores over time.
“Nonnarcotic analgesia might be feasible in providing postoperative pain relief to most patients following vaginal and perineal reconstructive repair,” concluded the researchers, adding that because all of the patients in this study underwent spinal anaesthesia, future studies would benefit from longer follow-up periods.
[Presentation title: Post-Operative Pain Management in Patients Undergoing Perineal and Vaginal Reconstructive Surgery: An Alternative to Narcotics. Abstract 121]