Reducing Postoperative Opioids after Minimally Invasive Hysterectomy with Suzetrigine at a Rural Louisiana Medical Center: A Quality Improvement Project

Abstract

Introduction:

We observed at our hospital that patients were using more opioids postoperatively than reported in the literature. We evaluated the efficacy of adding suzetrigine preoperatively to our enhanced recovery after surgery (ERAS) protocol, which utilizes premedication (acetaminophen, celecoxib, and pregabalin), then intraoperative subcutaneous liposomal bupivacaine followed by scheduled oral acetaminophen and ibuprofen postoperatively. Patients also have oxycodone as needed for breakthrough pain. The goal of this quality improvement project was to reduce postoperative opioid use at our hospital by 50%.

Materials and Methods:

We conducted an ambispective quality improvement project that included all patients who underwent total laparoscopic hysterectomy over a 1-year period. We then added suzetrigine to the other routine premedications. Patient medical records were evaluated for demographics, surgical characteristics, opioid type and dose, pain scores, length of stay, and complications. Opioids were converted to oral morphine dose equivalents.

Results:

In total, 68 patients were included within the preintervention and after-intervention cohorts. Mean opioid usage was lower in the postintervention group (13.3 mg vs. 28.5 mg, p < 0.001). After intervention, patients were five times more likely to decline opioids (p < 0.001) without any concomitant increase in pain scores. Furthermore, after the intervention, patients were 24 times more likely to be discharged on the day of surgery (p < 0.001).

Discussion:

The addition of suzetrigine to our ERAS protocol was associated with significant reductions in postoperative opioid use and mean pain scores. The quality improvement project met its stated goal of reducing postoperative opioid use by 50%.