Preemptive Analgesia in Minimally Invasive Gynecologic Surgery

Jaime Long, Kristin Bevil, Dobie L. Giles

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Preemptive analgesia is an intervention provided before initiating painful stimuli that may reduce or prevent subsequent pain. This systematic review examines the evidence supporting the practice of preemptive analgesia in minimally invasive gynecologic surgery (MIGS). We searched PubMed, Cochrane Register for Controlled Trials, and Embase from inception through February 26, 2018. The search was limited to human and English language studies. A total of 324 studies were identified. The abstracts were screened for relevance for minimally invasive gynecologic surgery (MIGS) and preemptive analgesia. The final trials reviewed were restricted to randomized controlled trials of preemptive medications given before the completion of MIGS surgery. Preemptive blocks (including paracervical, triple antibiotic paste, and pudendal) appear to have the most consistently beneficial effect on postoperative pain in MIGS with an excellent cost-benefit ratio, with the exception of liposomal bupivacaine, which requires further evaluation to determine if its added cost delivers better outcomes. Preemptive anticonvulsants, ketamine, and dexmedetomidine have a positive effect on postoperative pain and opioid use but are limited by side effects. Preemptive dexamethasone, acetaminophen, and nonsteroidal anti-inflammatory drugs have a modest effect on postoperative pain control. Despite these findings, additional quality work is needed to find more definitive methods of preemptive pain control for MIGS.

Original languageEnglish (US)
Pages (from-to)198-218
Number of pages21
JournalJournal of Minimally Invasive Gynecology
Volume26
Issue number2
DOIs
StatePublished - Feb 1 2019

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Gynecologic Surgical Procedures
Minimally Invasive Surgical Procedures
Analgesia
Postoperative Pain
Dexmedetomidine
Obstetrical Anesthesia
Pain
Bupivacaine
Ketamine
Acetaminophen
Ointments
PubMed
Anticonvulsants
Dexamethasone
Opioid Analgesics
Cost-Benefit Analysis
Anti-Inflammatory Agents
Language
Randomized Controlled Trials
Anti-Bacterial Agents

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology

Cite this

Long, Jaime ; Bevil, Kristin ; Giles, Dobie L. / Preemptive Analgesia in Minimally Invasive Gynecologic Surgery. In: Journal of Minimally Invasive Gynecology. 2019 ; Vol. 26, No. 2. pp. 198-218.
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Preemptive Analgesia in Minimally Invasive Gynecologic Surgery. / Long, Jaime; Bevil, Kristin; Giles, Dobie L.

In: Journal of Minimally Invasive Gynecology, Vol. 26, No. 2, 01.02.2019, p. 198-218.

Research output: Contribution to journalReview article

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