Preoperative Gabapentin for Minimally Invasive Hysterectomy: A Randomized Controlled Trial.

STUDY OBJECTIVE: To evaluate whether a single dose of gabapentin given preoperatively reduces narcotic use 24 hours after minimally invasive hysterectomy (MIH). DESIGN: Randomized controlled trial. SETTING: Single academic-affiliated community hospital. PATIENTS: Women undergoing MIH for benign indications between June 2016 and June 2017. INTERVENTIONS: Subjects were randomized to receive a preoperative regimen of acetaminophen, celecoxib, and gabapentin versus acetaminophen and celecoxib alone. MEASUREMENTS AND MAIN RESULTS: The primary outcome assessed was the total amount of narcotics used at 24 hours after surgery. Secondary outcomes included adverse effects from gabapentin use, total narcotics used, and pain scores at 2 weeks after surgery. A total of 129 women were randomized and eligible for analysis in the gabapentin study arm (n = 68) or the control arm (n = 61). Demographic characteristics and surgical details were similar between groups. Narcotics used at 24 hours after surgery totaling 168 versus 161 oral morphine milligram equivalents in the gabapentin and control groups, respectively, did not significantly differ between groups (p = .60). Total narcotics used and pain scores at 2 weeks after surgery and the rates of adverse effects from gabapentin were also similar between study arms. CONCLUSION: Single-dose, preoperative gabapentin for women undergoing benign MIH does not reduce total opioid use 24 hours after surgery.

Topical hemostatic and tissue-sealing agents in gynecologic surgery.

PURPOSE OF REVIEW: To review current topical hemostatic agent use and how it pertains to gynecologic surgery. RECENT FINDINGS: Recent literature suggests some benefit of topical hemostatic agents (THA). THAs confer reduced bleeding and shorter operating room time in women undergoing hysterectomy for cancer and in abdominal myomectomy. THA use in women undergoing ovarian cystectomy is associated with a decreased reduction in ovarian reserve. Potential complications of THA use include abscess formation, small bowel obstruction, inflammation, allergic reaction, and transmission of blood-borne pathogens. Evidence for use of THA in benign minimally invasive gynecologic surgery (MIGS) procedures is lacking. SUMMARY: Although evidence exists for the efficacy of THA in reducing blood loss and operating times across surgical subspecialties, specific, appropriate, and efficacious use of THAs in gynecologic surgery remains ill-defined. Knowledge of their mechanisms of action and potential complications should enable surgeons to optimize desired effects and minimize harm.

Prenatal care in a specialized diabetes in pregnancy program improves compliance with postpartum testing in GDM women.

OBJECTIVE: To evaluate whether prenatal care in a specialized diabetes in pregnancy program (DMC) improves compliance with completion of the 2-h 75 g oral glucose tolerance test (2HrOGTT) in GDM women. METHODS: A retrospective cohort study of GDM women delivering in a university health system between January 2011 and March 2014 was performed. Women were divided into two groups: those receiving care in prenatal clinics over an 18-month period prior to the establishment of the diabetes in pregnancy clinic (pre-DMC) and those receiving prenatal care in a specialized diabetes in pregnancy clinic (post-DMC). The primary outcome was completion of the 2HrOGTT postpartum. Clinical characteristics associated with 2HrOGTT completion were evaluated. Time trend analysis was performed to evaluate month to month variation in 2HrOGTT compliance for secular trends. RESULTS: A total of 292 women were analyzed, 147 post-DMC and 118 pre-DMC. The 2HrOGTT was ordered more frequently in the post-DMC compared to pre-DMC (90.0 versus 53.0%, p < 0.0001). Rates of completion of the 2HrOGTT were 49.2% post-DMC and 25.0% pre-DMC, p = 0.007. After adjusting for potential confounders, women who received prenatal care post-DMC were 2.98 times more likely to complete the 2HrOGTT compared to those receiving care pre-DMC (OR 2.98 [1.34, 6.62], p = 0.007). CONCLUSIONS: Providers were 5.9 times more likely to order the recommended testing for GDM women who attended the postpartum visit in the post-DMC period. GDM women who receive prenatal care in a specialized diabetes in pregnancy program are more likely to complete the 2HrOGTT in the postpartum period.