Preoperative Analgesia in Midurethral Sling: A Cohort Study.

INTRODUCTION AND HYPOTHESIS: 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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.