Ortega Marcus, Taboada Mireya, Dotson Elizabeth, James Kaitlyn, Silfen Alexa, Kim-Ortega Youngwu, Weinstein Milena, Ellis Dan
Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital, Boston, MA, USA.
Int Urogynecol J. 2025 Apr 30. doi: 10.1007/s00192-025-06135-9.
Stress urinary incontinence (SUI) is a common condition among adult women in the USA, with its prevalence expected to rise owing to an aging population. Midurethral sling (MUS) procedures are a well-established surgical treatment for SUI. Enhanced Recovery After Surgery (ERAS) protocols advocate for multimodal pain management strategies, including preoperative analgesia. However, limited data exist on the effectiveness of preoperative pain medications in MUS procedures. This study examines the impact of preoperative analgesia on postoperative pain scores and opioid consumption.
A retrospective cohort study analyzed women who underwent MUS placement between 2018 and 2022 within a New England health care system. Patients were stratified by preoperative pain medication use. Primary outcomes included postoperative pain scores and opioid consumption. Secondary outcomes assessed anesthesia type, sling type, and operative time. Multivariable regression analyses adjusted for confounders.
A total of 631 patients met the inclusion criteria, with 400 receiving preoperative pain medications. Patients with preoperative analgesia had significantly lower median postoperative pain scores (p = 0.013) and were more likely to achieve acceptable pain control (p = 0.014). However, adjusted analyses found no significant difference in opioid consumption or pain scores between groups.
Preoperative pain medications were associated with improved pain scores in unadjusted analyses but did not demonstrate independent statistical significance after adjusting for confounders. These findings highlight the complexity of pain management in MUS procedures. Further randomized studies are needed to refine ERAS pain strategies in urogynecological surgery.
压力性尿失禁（SUI）在美国成年女性中很常见，由于人口老龄化，其患病率预计还会上升。中段尿道吊带术（MUS）是一种成熟的SUI手术治疗方法。术后加速康复（ERAS）方案提倡多模式疼痛管理策略，包括术前镇痛。然而，关于术前止痛药在MUS手术中的有效性的数据有限。本研究探讨术前镇痛对术后疼痛评分和阿片类药物消耗量的影响。
一项回顾性队列研究分析了2018年至2022年在新英格兰医疗系统内接受MUS植入术的女性。患者根据术前止痛药的使用情况进行分层。主要结局包括术后疼痛评分和阿片类药物消耗量。次要结局评估麻醉类型、吊带类型和手术时间。多变量回归分析对混杂因素进行了调整。
共有631例患者符合纳入标准，其中400例接受了术前止痛药治疗。术前接受镇痛的患者术后中位疼痛评分显著更低（p = 0.013），且更有可能实现可接受的疼痛控制（p = 0.014）。然而，调整分析发现两组之间在阿片类药物消耗量或疼痛评分上没有显著差异。
在未调整的分析中，术前止痛药与疼痛评分改善相关，但在调整混杂因素后未显示出独立的统计学意义。这些发现凸显了MUS手术中疼痛管理的复杂性。需要进一步的随机研究来完善ERAS在泌尿妇科手术中的疼痛策略。
