Best Practice Analgesic Management for Minimally Invasive Gynecologic Procedures at Corewell Health East - Royal Oak

Background: Non-opioid analgesics and analgesic adjuncts have been used successfully in a variety of surgical procedures, including minimally invasive gynecologic procedures that elicit pain via uterine muscle cramps. Non-steroidal anti-inflammatory drugs (NSAIDs) are considered the gold standard in the treatment of pain caused by uterine cramping. Additionally, research shows analgesic benefits of IV magnesium sulfate and acetaminophen.
Purpose: The purpose of this DNP project was to evaluate the current analgesic practice of perioperative opioid administration for minimally invasive gynecological procedures at Corewell Health East - Royal Oak. Additionally, an examination of whether opioid administration or non-opioid analgesia is considered evidence-based best practice for minimally invasive gynecological procedures. Methods: Data on analgesic medication administration during hysteroscopy and/or dilation and curettage procedures was collected through a retrospective electronic medical record review of 59 patients. Data pertaining to patient age, type of surgical procedure, timing of analgesic medication administration and dosages were considered. Results: Findings demonstrate that the average dose of fentanyl administered was 45.34 micrograms. There is no statistically significant difference in opioid administration between different phases of anesthesia, dosage of fentanyl between different age groups, or between procedures.
Conclusion: Current literature advocates for minimizing opioid administration, while supporting effectiveness of non-opioid analgesics, such as NSAIDs, magnesium sulfate and acetaminophen for the treatment of mild to moderate pain caused by uterine cramping following minimally invasive gynecological procedures.