Eliminating opioid prescriptions from outpatient minimally invasive gynecologic surgery: a randomized trial

Despite low pain scores after minimally invasive gynecologic surgery (MIGS), opioids remain overprescribed in patients undergoing these procedures. In a single-blind randomized trial conducted at a tertiary-care academic center, we assessed whether a multimodal opioid-free exit prescription (OFP) for analgesia would result in noninferior postoperative pain control compared to an opioid-containing prescription in patients undergoing MIGS. Female patients without prior pain conditions undergoing outpatient laparoscopic MIGS were randomized to receive either an OFP or a restrictive opioid prescription (ROP; five tablets hydromorphone 1 mg) alongside multimodal analgesia. The primary outcome was patient-reported pain on postoperative day (POD) 1. Secondary outcomes included patient-reported pain and measures of recovery such as total opioid consumption, participant mobility, opioid-related side effects, return to emergency room or clinic, need for rescue analgesia prescription, overall satisfaction with pain control and overall satisfaction with postoperative care, which were assessed on POD1 and POD7 by a blinded outcome assessor. Of n = 110 patients randomized, n = 103 completed the study (OFP = 49, ROP = 54). No significant difference in mean pain scores on POD1 (3.1 versus 3.5, P = 0.31) or POD7 (1.0 versus 1.5, P = 0.14) were found. Mobility and satisfaction were comparable. ROP patients experienced more nausea and vomiting (14.3% versus 35.2%, P = 0.01). No OFP patients required rescue opioids. Only 27.8% and 11.1% of ROP patients consumed opioids by POD1 and POD7 respectively. Thus, in patients undergoing outpatient MIGS, an OFP resulted in noninferior postoperative pain compared to an ROP, suggesting that opioids may be safely omitted in this clinical context. ClinicalTrials.gov identifier: NCT04837014 .