Author Credentials

Kevin D. White MD Shirin Azadi BS Amanda Pauley MD Brenda L. Mitchell MD Nadim Bou Zgheib MD


Enhanced Recovery after surgery, ERAS, Multimodal, Opioids, Pain Control, Substance abuse


Medicine and Health Sciences | Obstetrics and Gynecology




We evaluated the efficacy of various strategies utilized for the control of postoperative pain after minimally invasive hysterectomy. The primary enhanced recovery after surgery (ERAS) protocol of interest utilized premedication (acetaminophen, celecoxib and pregabalin), then intraoperative subcutaneous liposomal bupivacaine followed by scheduled oral acetaminophen and ibuprofen postoperatively. Patients also had tramadol and oxycodone as needed for moderate or severe breakthrough pain, respectively.

Materials and Methods:

We conducted a retrospective cohort study that included all patients who underwent minimally invasive hysterectomy (total laparoscopic hysterectomy and laparoscopic-assisted vaginal hysterectomy) for both benign and oncologic indications over a 2-year period. We then compared six protocols, with 3 being ERAS protocols and 3 as traditional pain control methods. The control group was comprised of the traditional pain control group without intraoperative placement of local analgesia. 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.


954 patients were included within the 6 protocols. Median opioid usage was the lowest in the ERAS group with premedication and highest in the control group (22.5mg versus 55.0mg, p


ERAS protocol with premedication was associated with significant reductions in postoperative opioid use and median pain scores when compared to traditional methods.