AUTHOR=Geng Zhiyu , Wang Bojie , Zhang Yan , Yan Xin , Hu Jun , Cui Ran , Song Linlin 

TITLE=Preemptive multimodal analgesia for gynecologic oncology patients undergoing laparotomy: a randomized controlled trial

JOURNAL=Frontiers in Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1427548

DOI=10.3389/fmed.2024.1427548

ISSN=2296-858X

ABSTRACT=Purpose: Gynecologic oncology laparotomy leads to severe postoperative pain. We aimed to evaluate the effects of preemptive multimodal analgesic regimen on postoperative opioid consumption for patients undergoing gynecologic oncology laparotomy.In this prospective, randomized clinical trial, 80 female patients scheduled for gynecologic oncology laparotomy were randomized to receive preemptive multimodal analgesia consisted of transversus abdominis plane (TAP) block, cyclooxygenase-2 inhibitors, acetaminophen and intravenous morphine patient-controlled analgesia (PCA) (Study group) or conventional analgesia with cyclooxygenase-2 inhibitors and morphine PCA (Control group). The primary outcome was morphine consumption in the first 24 hours after surgery. Secondary outcomes were pain scores, nausea, vomiting, time to ambulation and flatus, length of hospital stay, satisfaction score, the 40-item Quality of Recovery score (QoR-40) and the Short-Form Health Survey (SF-36) scale.Results: Morphine consumption in the first 24 hours was 6 (3-9.8) mg in the Study group and 7 (3.5-12.5) mg in the Control group (p=0.222). The Study group showed lower morphine consumption up to 6 hours, lower pain scores up to 48 hours, and earlier time to ambulation and flatus. The global QoR-40 score at 48 hours (182[173-195] vs. 173.5[154-185.5], p=0.024), subdimension scores of physical dependence at 24 hours, physical comfort and pain at 48 hours were significantly improved in the Study group.Conclusions: Preemptive multimodal analgesia was not superior to conventional analgesia in reducing 24 hours morphine consumption; however, it showed a significantly improved pain control and early quality of recovery thus can be recommended for gynecologic oncology patients undergoing laparotomy.