title: Multimodal pain control is associated with reduced hospital stay following open abdominal hysterectomy.
abstract: OBJECTIVE
  To study the association of a multimodal pain protocol (MMPC) and reduced hospital stay after open abdominal hysterectomy.
  
  
  METHODS
  The study design was a comparison of a prospective cohort with a retrospective historical control. We enrolled endometrial cancer patients undergoing open abdominal hysterectomy with lymphadenectomy by the same surgeon. Control patients from 2008 to 2010 who received morphine PCA alone were compared with a similar demographic group of patients from 2011 to 2013 who received MMPC. MMPC consisted of gabapentin (900mg PO) and acetaminophen (1g IV) administered 45-60min preoperatively. The surgical site was injected with bupivacaine with 0.5% epinephrine prior to incision. The postoperative pain control regimen consisted of gabapentin (300mg PO every 6h), acetaminophen (1g IV every 8h for 24h postoperatively), ketorolac (15mg IV every 6h for 48h postoperatively), morphine PCA (2mg IV every 10min, no basal rate) and oxycodone/acetaminophen (10/325mg PO every 6h as needed).
  
  
  RESULTS
  Length of hospital stay (LOH) of the study cohort (N=105 with MMPC) was compared with the historical with postoperative morphine alone (N=113 without MMPC). There were no differences in demographic, uterine cancer stage, or comorbidities between the two arms. The LOH was 1.6 days for patients receiving MMPC and 3.3 days for patients who received morphine alone (P<0.001).
  
  
  CONCLUSIONS
  Multimodal pain control is associated with significantly reduced hospital stay after open abdominal hysterectomy.
authors.affiliation: West Clinic, Memphis, TN, United States.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Santoso
authors.affiliation: West Clinic, Memphis, TN, United States. Electronic address: mulm@uthsc.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Ulm
authors.affiliation: West Clinic, Memphis, TN, United States.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Jennings
authors.affiliation: West Clinic, Memphis, TN, United States.
authors.forename: Jim Y
authors.initials: JY
authors.lastname: Wan
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D016889:Endometrial Neoplasms / Q000601:surgery*; D005260:Female; D000077206:Gabapentin; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D000082:Acetaminophen; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D009020:Morphine; D002045:Bupivacaine
keywords: Hospitalization; Hysterectomy; Multimodal; Pain; Postoperative