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Pain Management Strategies for Urogynecologic Surgery: A Review

Collins, Sarah A. MD*; Joshi, Girish MD; Quiroz, Lieschen H. MD; Steinberg, Adam C. DO§; Nihira, Mikio A. MD, MPH

Female Pelvic Medicine & Reconstructive Surgery: November/December 2014 - Volume 20 - Issue 6 - p 310–315
doi: 10.1097/SPV.0000000000000134
Original Articles

Objectives The objectives of this study were to review the recent literature on surgical pain management strategies and to identify those pertinent to urogynecologic surgery.

Methods A literature search using Pubmed and MEDLINE was performed for trials on pain management in gynecologic surgery. Evidenced-based recommendations for preoperative, intraoperative, and postoperative pain control strategies for gynecologic procedures by various surgical routes were identified. Articles specifically describing urogynecologic procedures were sought, but quality, randomized trials on pain management modalities in other gynecologic procedures were also included.

Results Although few randomized trials on pain management strategies in urogynecologic surgery exist, quality evidence suggests that several preemptive and multimodal analgesia strategies reduce pain and opioid-related adverse events in abdominal, laparoscopic, and vaginal surgery. Evidence supporting these strategies is outlined. Many are likely applicable to urogynecologic procedures.

Conclusions Evidence guiding pain management in specific urogynecologic procedures is sparse and should be sought in future studies. When possible, procedure-specific strategies, including preemptive and multimodal techniques, should be implemented.

Pain management techniques in urogynecologic surgery should include pre-emptive, multimodal, and procedure-specific strategies when possible.

From the *Department of Obstetrics and Gynecology, Section of Gynecology and Reconstructive Pelvic Surgery, University of Chicago Medicine, Chicago, IL; †Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Houston, TX; ‡Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK; and §Department of Obstetrics and Gynecology, Division of Urogynecology, Hartford Hospital, University of Connecticut Health Center, Hartford, CT.

Reprints: Sarah A. Collins, MD, Department of Obstetrics and Gynecology, Section of Gynecology and Reconstructive Pelvic Surgery, University of Chicago Medicine, 5841 S Maryland Ave, MC 2050, Chicago, IL 60637. E-mail:

The authors have declared that they have no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins