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Preoperative Analgesia in Midurethral Sling: A Cohort Study
Marcus Ortega1, Mireya Taboada2, Elizabeth Dotson2
1Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. mortega7@mgh.harvard.edu.
International Urogynecology Journal
|April 30, 2025
Summary
Preoperative pain medication for midurethral sling procedures showed improved pain scores in initial analysis but lacked statistical significance after adjustments. Further research is needed for enhanced recovery after surgery pain strategies.
Area of Science:
- Urogynecology
- Surgical Pain Management
Background:
- Stress urinary incontinence (SUI) affects many women, with midurethral sling (MUS) procedures being a common surgical treatment.
- Enhanced Recovery After Surgery (ERAS) protocols recommend preoperative analgesia, but its effectiveness in MUS is not well-established.
Purpose of the Study:
- To investigate the impact of preoperative pain medication on postoperative pain and opioid use in women undergoing MUS placement.
- To evaluate the role of preoperative analgesia within ERAS protocols for urogynecological surgery.
Main Methods:
- Retrospective cohort study of 631 women undergoing MUS placement (2018-2022).
- Patients were grouped based on preoperative pain medication use.
- Primary outcomes: postoperative pain scores and opioid consumption; adjusted for confounders using multivariable regression.
Main Results:
- Patients receiving preoperative analgesia reported lower unadjusted postoperative pain scores (p=0.013) and better pain control (p=0.014).
- However, adjusted analyses revealed no significant differences in pain scores or opioid consumption between groups.
Conclusions:
- Preoperative pain medication showed a trend towards improved pain control in unadjusted analysis for MUS surgery.
- Adjusted results indicate no independent statistical significance, highlighting the complexity of pain management.
- Further randomized trials are necessary to optimize ERAS pain strategies in urogynecological procedures.
