Women undergoing procedures or surgeries related to infertility experience pain, which is often treated with opioid medication. This creates some important clinical considerations. For patients who are opioid naive, exposure to these addictive medications may be a trigger for persistent use. Data from reproductive procedures are limited, but recent data suggest that opioid exposure after other surgeries confers an increased risk for chronic opioid use. For women who are taking chronic opioids or opioid replacement therapy, tolerance to opioids has the potential to make pain management more difficult. Likewise, women who have a history of an opioid use disorder may wish to avoid opioid medications, given concerns about the potential relapse. For these reasons it is important for all patients, but particularly those with a history of opioid use disorder or dependence, to optimize the treatment of pain in the perioperative period with non-opioid analgesics. In this review we present evidence-based strategies for non-opioid perioperative pain management demonstrated to improve postoperative pain scores and/or decrease consumption of opioids, and provide recommendations for implementation following common reproductive surgeries and procedures.

A variety of non-opioid analgesics are available, which can be used as part of a multimodal analgesic regimen to reduce the need for opioid analgesics. The two most commonly used classes of non-opioid analgesics are nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. Gabapentinoids are also becoming an increasingly popular component of multimodal analgesia and are now included in many enhanced recovery after surgery protocols. Nonsteroidal anti-inflammatory drugs inhibit cyclooxygenase (COX) enzymes to prevent the metabolism of arachidonic acid released from damaged tissue to prostaglandins, which in turn lowers the pain threshold in peripheral nociceptors. These medications can be administered preoperatively, intraoperatively, or postoperatively. Preoperative administration of NSAIDs may be beneficial as a preemptive analgesic. They have been demonstrated to improve pain control for many surgical procedures. Though there is a theoretical concern owing to their effect on platelet function, evidence suggests that the use of NSAIDs generally does not increase the risk for periprocedural bleeding.

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Mishita
Jornal co-ordinator
Journal of General Surgery Reports