Author Credentials

Kevin D. White MD William C. Wallace MD Nadim Zgheib MD, FACOG


Enhanced Recovery after Surgery, ERAS, Multimodal, Opioids, Pain Control, Substance Abuse


Obstetrics and Gynecology



We evaluated the efficacy of a multimodal pain regimen that approaches pain control by utilizing different mechanisms of action. This novel protocol utilizing liposomal bupivacaine, acetaminophen, tramadol and oxycodone as needed in reducing the overall opioid use by patients after undergoing robotic-assisted total laparoscopic hysterectomy in an obese population that is heavily afflicted by the opioid epidemic.

Materials and Methods:

We conducted a retrospective study wherein a sample of 100 (50 multimodal group and 50 controls) were taken from 433 eligible cases conducted over a 1 year period. 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.


Overall opioid use in the multimodal group decreased by 54% (75.1mg versus 35.5mg, p


A multimodal approach to pain control is an acceptable alternative to traditional methods of pain control, regardless of BMI, for those with benign or malignant disease and decreases opioid use by 44 to 62 percent with no concomitant increase in pain scores and may decrease pain by 9 to 24 percent.