A Randomized Controlled Trial for Dual-Agent Local Analgesic in Sling Surgery

Narcotic use after retropubic suburethral sling surgery is not unusual. Surgeons may consider using topical analgesics to minimize narcotic use.

The aim of the study was to determine if using bupivacaine-meloxicam (Zynrelef) reduces narcotic use in the first 3 days after surgery, measured as morphine milligram equivalents (MME). Secondary aims were to compare, postoperatively, average and worst pain, satisfaction with pain control and quality of recovery between groups.

This was a single-center prospective single-blinded randomized controlled trial for women undergoing retropubic sling surgery. The intervention arm received Zynrelef at the suprapubic incisions, no placebo was used in controls. Participants tracked pain levels, medication use, satisfaction with pain control and Quality of Recovery surveys in the first 3 postoperative days. Appropriate statistical analyses were applied.

A total of 119 women were randomized. For primary outcome, totalmedian MME from postoperative days 0-3, the control group used 37.5 MME compared to 30 MME in the Zynrelef group (interquartile range [IQR] 5.63-71.25; P  = 0.61). Pain scores were low in both groups, participants were satisfied or very satisfied with pain control. Quality of recovery scores were similar between groups, with improvement by postoperative day 3 to near baseline scores. Patients with anxiety/depression used more oxycodone; 10 mg (IQR 0-30) vs 0 mg (IQR 0-15), P  = 0.0027.

Use of Zynrelef during retropubic sling surgery does not reduce narcotic use in the first 3 days postoperatively. Patients can be reassured that pain and narcotic use after surgery are low and recovery is quick.