Multimodal Opioid Sparing Anesthesia for Women Undergoing Robotic-Assisted Laparoscopic Hysterectomy

Background: The opioid overdose epidemic is a public health crisis in the United States. According to the Centers for Disease Control and Prevention (CDC, 2019), in 2017, there were over 70,000 overdose deaths, of which more than 47,000 involved opioids. Opioid-related deaths have led to a decline in life expectancy and have become the leading cause of unintentional death. A patient’s first exposure to opioids may be during the perioperative period. Anesthesia providers are equipped to decrease or eliminate the use of opioids by utilizing multimodal analgesia (Koepke et al., 2018).
Purpose: Patients who received multimodal therapy were three times more likely to decline opioids without any concomitant increase in pain compared to an opioid-only cohort following laparoscopic hysterectomy (White et al., 2019). The purpose of this project was to implement an evidence-based protocol in multimodal anesthesia to spare the amount of opioids administered during the performance of robotic-assisted laparoscopic hysterectomies at a local hospital.
Methods: Following IRB approval, all relevant perioperative staff was educated about multimodal opiate sparing techniques, pain assessment, and implementing the project. Patients were informed and consented. A Multimodal Opioid Sparing Anesthetic (MOSA) technique was utilized. If opioids were administered, they were converted to morphine dose equivalents (MMEs) for ease of comparison. Before the operation and upon arrival to the Post Anesthesia Care Area (PACU), pain scores were recorded.