Preemptive Analgesia to Control Postop Hysterectomy Pain: The SGS Clinical Guidelines
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the outcomes associated with poor pain control and over reliance on narcotics 2. Restate the recommendations by the Society of Gynecologic Surgeons for preferred preemptive pain medications
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Designated for 0.2 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
Poor postoperative pain control, as well as narcotic side effects of nausea/vomiting, constipation and sedation not only adversely impact patients’ satisfaction with the surgical experience, but can result in extended hospital stay, readmission, delayed return to daily activities, delayed ambulation and overall increased morbidity. The SGS, based on a systematic review (2486 abstracts and 84 articles), conceived the following guidance on preemptive analgesia, defined as any treatment given prior to completion of abdominal hysterectomy. The focus of these recommendations is to decrease postoperative narcotic consumption and improve patient satisfaction.
Recommended Use of Preemptive Medications Prior to Abdominal Hysterectomy
Choice of preemptive pain medication
Gabapentin, acetaminophen (paracetamol), NSAIDs, COX-2 inhibitors or narcotics used individually (1A – strong recommendation/high quality evidence) or in combination (2A – weak recommendation/high quality evidence)
If using narcotics, use higher preemptive doses to reduce postop narcotic requirements (2B – weak recommendation/moderate quality evidence)
Preemptive NSAIDS reduce pain (2A) and total postoperative narcotic consumption (2A)
Preemptive phenothiazine should be given to patients at higher risk of nausea and vomiting (1A)
There is no increased blood loss, length of procedure or duration of hospital stay when preemptive pain medications are used (2A) and therefore these concerns should not be used to limit use of preemptive pain medications
Note: Level 1 evidence should be considered ‘recommended’, while level 2 is ‘suggested’
Pre- and intra-operative analgesia, whether narcotic or nonnarcotic, can improve postoperative pain scores, reduce postoperative narcotic requirements, and result in improved patient satisfaction
A bupivacaine transversus abdominis plane block results in lower narcotic requirements than subdermal or intravenous bupivacaine
Acetaminophen plus gabapentin is superior to gabapentin alone
NSAIDs, specifically ibuprofen, indomethacin and meloxicam, effectively reduce postoperative pain
COX -2 inhibitors do not decrease postoperative pain, but decrease total narcotic consumption and improve patient satisfaction
Preemptive narcotics improve pain scores more than nonnarcotics but increase sedation
Preemptive analgesia does not adversely impact risk of surgical complications and improve both postoperative pain scores and patient satisfaction.
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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