Pain intensity and opioid consumption in patients with endometriosis after robotic or laparoscopic-assisted gynecology surgery: a retrospective cohort study

Position du problème et objectif(s) de l’étude

Endometriosis is an estrogen-dependent inflammatory disease that affects approximately 10% of women in their reproductive years1. Depression2, anxiety2, and chronic pelvic pain3 are frequently observed among endometriosis surgical candidates, leading to complex perioperative pain management. Although effective pain management is essential for promoting early recovery, postoperative pain intensity and opioid consumption data remain extremely limited to very small cohort studies345. This study thus aims to retrospectively evaluate the postoperative pain intensity and opioid consumption of patients with endometriosis undergoing minimally invasive laparoscopic or robotic gynecology surgery.

Matériel et méthodes

After IRB approval (IRB-25-0203) on February 18, 2025, all consecutive adult patients with endometriosis who underwent a minimally invasive laparoscopic or robotic gynecology surgery between 2013 and 2024 at Ronald Reagan and Santa Monica hospitals (UCLA, USA) were retrospectively analyzed and their data collected. Data were extracted from the UCLA electronic medical record system. The co-primary endpoints were maximal pain score on the Numerical Rating Scale (NRS) and total opioid consumption, expressed in morphine milligram equivalents (MME), at the end of the day of surgery (postoperative day #0). Secondary endpoints, all evaluated in the post anesthesia care unit (PACU), included the incidence of postoperative nausea and vomiting (PONV), maximal pain scores and total MME.

Résultats & Discussion

During the study period, 1,989 cases were performed and analyzed. The baseline characteristics are shown in Table 1. Maximal NRS and total MME (median [Q1-Q3]) were 6 [4-8] and 12 mg [3-25] for the PACU and 7 [5-8] and 14 mg [6-26] for POD 0 (Figure 1). The incidence of PONV was 17%. Importantly, a transversus abdominus plane block was performed in 17% of cases, while 21% received an intravenous ketamine continuous infusion. A combination of regional anesthesia and at least one IV analgesic adjuvant (either ketamine, lidocaine, magnesium, or dexmedetomidine) was used in 36% of patients. Acetaminophen was used in 64 % and ketorolac in 34 %. Their combination was administered in 75% of patients. Higher levels of worst postoperative pain reported in U.S. patients compared to international cohorts6 may contribute to these results. While the United States still overprescribes opioids after surgery compared to other countries7, both patient8 and healthcare provider9 education regarding opioid use may also help explain these findings. The absence of a matched comparison group without endometriosis and the retrospective design limit the strength of our conclusions. Additionally, opioids consumption and pain scores upon discharge were not reported.

Conclusion

Patients with endometriosis undergoing laparoscopic or robotic-assisted gynecology surgery experienced relatively high pain scores which subsequently lead to high opioid consumption on the day of surgery. Further studies are needed to identify effective analgesia strategies for adequate postoperative pain control.

Auteurs

Yann GRICOURT (1), Jorgi BUGOSEN (2) , Theodora WINGERT (1), Brenton ALEXANDER (3), Turgay TUNA (2), Alexandre JOOSTEN (1) - (1)Department Of Anesthesiology & Perioperative Medicine, David Geffen School Of Medicine At Ucla, University Of California Los Angeles, California, Usa., Los Angeles, États-Unis, (2)Department Of Anesthesiology, Erasme University Hospital, Brussels, Belgium-Brussels (belgique), Brussels, Belgique, (3)Department Of Anesthesiology, Uc San Diego School Of Medicine, La Jolla, California, Usa-San Diego (états-Unis), San Diego, États-Unis

Orateur(s)

Jorgi BUGOSEN (Brussels)