Preemptive Non-narcotic Pain Medication prior to Minimally Invasive Surgery in Gynecologic Oncology

ABSTRACT Study Objective To review the impact of an enhanced recovery after surgery (ERAS) after minimally invasive surgery (MIS) with respect to peri-operative narcotics, time in the recovery room, and total time in hospital. Design Retrospective cohort Setting Teaching hospital Patients All patients having minimally invasive surgery in the division of gynecologic oncology during a 20 month period. Intervention MIS cases were compared before and after the implementation of an ERAS protocol that incorporated orally administered acetaminophen, gabapentin and celecoxib. Measurement & Main Results A total of 800 MIS cases were performed during the period (77% laparoscopy, 18% robotic, 5% mini-lap).  Of these, 449 were treated without and 351 were treated with the ERAS protocol.  There were no significant differences between the groups with respect to age, BMI, surgery type, smoking, surgical indication, blood loss, or diagnosis. Total narcotic use in milligram intravenous equivalents of morphine (mg IV Eq) was significantly less in the ERAS patients (28.5 mg IV Eq vs 23.6 mg IV Eq; P Conclusions Implementation of an ERAS protocol for MIS appears to reduce total peri-operative narcotic use but does not reduce recovery room time. There was a reduction in total hospital time, but this may be dependent on practice patterns of individual physicians.