Current Bladder Dysfunction Reports

, Volume 13, Issue 4, pp 282–287 | Cite as

Optimizing Postoperative Pain Management in Pelvic Floor Surgery

  • Dena Moskowitz
  • Una LeeEmail author
Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Reconstructed Bladder Function & Dysfunction


Purpose of Review

Surgical treatment of pelvic floor dysfunction is very common, and women who undergo surgery experience varying degrees of postoperative pain. Opioid pain medications have been the mainstay of postoperative pain control, but with the growing opioid epidemic, alternative pain management strategies are needed. This review examines the current literature on opioid use in pelvic floor surgery, non-opioid pain control strategies, and surgical approach as it pertains to postoperative pain.

Recent Findings

Over prescription of opioids is common in pelvic floor surgery and it poses a risk of developing long-term opioid dependence. Alternative pain control strategies include non-opioid medications, multimodal medication regimens, and local anesthetic. The type of surgical approach can have a bearing on the degree of postoperative pain.


Optimal pain control after pelvic floor surgery involves multiple components that should be individualized to each patient. The components should include minimizing opioid pain medications, shared decision-making in surgical approach, and a perioperative pathway that maximizes the recovery process. Future studies should continue to explore ways to improve patient comfort and satisfaction after pelvic floor surgery.


Opioid Analgesia Pelvic floor Pelvic organ prolapse Midurethral sling Urinary incontinence 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Nygaard I. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6.CrossRefGoogle Scholar
  2. 2.
    Wu JM, Matthews CA, Conover MM, Pate V, Jonsson FM. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6.CrossRefGoogle Scholar
  3. 3.
    • Kolodny A, Courtwright DT, Hwang CS, Kreiner P, Eadie JL, Clark TW, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36(1):559–74 This article provides an in-depth review of the opioid problem in the USA, including the history, trends over time, and the impact of the epidemic. CrossRefGoogle Scholar
  4. 4.
    Bates C, Laciak R, Southwick A, Bishoff J. Overprescription of postoperative narcotics: a look at postoperative pain medication delivery, consumption and disposal in urological practice. J Urol. 2011 Feb;185(2):551–5.CrossRefGoogle Scholar
  5. 5.
    Kumar K, Gulotta LV, Dines JS, Allen AA, Cheng J, Fields KG, et al. Unused opioid pills after outpatient shoulder surgeries given current perioperative prescribing habits. Am J Sports Med. 2017 Mar;45(3):636–41.CrossRefGoogle Scholar
  6. 6.
    Hill MV, McMahon ML, Stucke RS, Barth RJ. Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg. 2017;265(4):709–14.CrossRefGoogle Scholar
  7. 7.
    Swenson CW, Kelley AS, Fenner DE, Berger MB. Outpatient narcotic use after minimally invasive urogynecologic surgery. Female Pelvic Med Reconstr Surg. 2016;22(5):377–81.CrossRefGoogle Scholar
  8. 8.
    Porter J, Jick H. Addiction rare in patients treated with narcotics. N Engl J Med. 1980;302:123.PubMedGoogle Scholar
  9. 9.
    Alam A. Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med. 2012;172(5):425–30.CrossRefGoogle Scholar
  10. 10.
    Sun EC, Darnall BD, Baker LC, Mackey S. Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med. 2016;176(9):1286–93.CrossRefGoogle Scholar
  11. 11.
    Calcaterra SL, Yamashita TE, Min S-J, Keniston A, Frank JW, Binswanger IA. Opioid prescribing at hospital discharge contributes to chronic opioid use. J Gen Intern Med. 2016;31(5):478–85.CrossRefGoogle Scholar
  12. 12.
    Thompson JC, Komesu YM, Qeadan F, Jeppson PC, Cichowski SB, Rogers RG, et al. Trends in patient procurement of postoperative opioids and route of hysterectomy in the United States from 2004 through 2014. Am J Obstet Gynecol [Internet]. 2018 Jul [cited 2018 Aug 28]; Available from:
  13. 13.
    Hota LS, Warda HA, Haviland MJ, Searle FM, Hacker MR. Opioid use following gynecologic and pelvic reconstructive surgery. Int Urogynecology J. 2017 Sep 9 [cited 2018 Aug 28]; Available from:;29:1441–5.CrossRefGoogle Scholar
  14. 14.
    Clarke H, Soneji N, Ko DT, Yun L, Wijeysundera DN. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ. 2014;348(feb11 3):g1251.CrossRefGoogle Scholar
  15. 15.
    • Shah AS, Blackwell RH, Kuo PC, Gupta GN. Rates and risk factors for opioid dependence and overdose after urological surgery. J Urol. 2017;198(5):1130–6 This large database study evaluates rates and risk factors for opioid dependence and overdose within urologic surgery. CrossRefGoogle Scholar
  16. 16.
    Butler K, Yi J, Wasson M, Klauschie J, Ryan D, Hentz J, et al. Randomized controlled trial of postoperative belladonna and opium rectal suppositories in vaginal surgery. Am J Obstet Gynecol. 2017;216(5):491.e1–6.CrossRefGoogle Scholar
  17. 17.
    Crisp CC, Khan M, Lambers DL, Westermann LB, Mazloomdoost DM, Yeung JJ, et al. The effect of intravenous acetaminophen on postoperative pain and narcotic consumption after vaginal reconstructive surgery: a double-blind randomized placebo-controlled trial. Female Pelvic Med Reconstr Surg. 2017;23(2):80–5.CrossRefGoogle Scholar
  18. 18.
    Li ALK, Wadsworth K, Siddiqui NT, Alarab M, McDermott CD, Lemos N, et al. Does low-dose gapapentin reduce opioid use postoperatively?: a randomized controlled trial in women undergoing reconstructive pelvic surgery. Int Urogynecology J [Internet]. 2018 Mar 21 [cited 2018 Aug 28]; Available from:
  19. 19.
    Ferrando CA, Walters MD. A randomized double-blind placebo-controlled trial on the effect of local analgesia on postoperative gluteal pain in patients undergoing sacrospinous ligament colpopexy. Am J Obstet Gynecol. 2018;218(6):599.e1–8.CrossRefGoogle Scholar
  20. 20.
    Yeung J, Crisp CC, Mazloomdoost D, Kleeman SD, Pauls RN. Liposomal bupivacaine during robotic colpopexy and posterior repair. Obstet Gynecol 2018;131:39–46.Google Scholar
  21. 21.
    Mazloomdoost D, Pauls RN, Hennen EN, Yeung JY, Smith BC, Kleeman SD, et al. Liposomal bupivacaine decreases pain following retropubic sling placement: a randomized placebo-controlled trial. Am J Obstet Gynecol. 2017;217(5):598.e1–598.e11.CrossRefGoogle Scholar
  22. 22.
    Dueñas-Garcia OF, Patterson D, De la Luz Nieto M, Leung K, Flynn MK. Voiding function after midurethral slings with and without local anesthetic: randomized controlled trial. Female Pelvic Med Reconstr Surg. 2017;23(1):56–60.CrossRefGoogle Scholar
  23. 23.
    Reagan KML, O’Sullivan DM, Gannon R, Steinberg AC. Decreasing postoperative narcotics in reconstructive pelvic surgery: a randomized controlled trial. Am J Obstet Gynecol. 2017;217(3):325.e1–325.e10.CrossRefGoogle Scholar
  24. 24.
    Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg. 2014;38(6):1531–41.CrossRefGoogle Scholar
  25. 25.
    Azhar RA, Bochner B, Catto J, Goh AC, Kelly J, Patel HD, et al. Enhanced recovery after urological surgery: a contemporary systematic review of outcomes, key elements, and research needs. Eur Urol. 2016;70(1):176–87.CrossRefGoogle Scholar
  26. 26.
    •• Carter-Brooks CM, Du AL, Ruppert KM, Romanova AL, Zyczynski HM. Implementation of a urogynecology-specific enhanced recovery after surgery (ERAS) pathway. Am J Obstet Gynecol [Internet]. 2018 Jun [cited 2018 Aug 28]; Available from: The first description of a pelvic floor reconstruction-specific ERAS protocol. The protocol includes multiple factors that can be incorporated into practice including patient education, preoperative preparation, and postoperative care.
  27. 27.
    Paraiso MFR, Jelovsek JE, Frick A, Chen CCG, Barber MD. Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial. Obstet Gynecol. 2011;118(5):1005–13.CrossRefGoogle Scholar
  28. 28.
    Anger JT, Mueller ER, Tarnay C, Smith B, Stroupe K, Rosenman A, et al. Robotic compared with laparoscopic sacrocolpopexy: a randomized controlled trial. Obstet Gynecol. 2014 Jan;123(1):5–12.CrossRefGoogle Scholar
  29. 29.
    Westermann LB, Crisp CC, Mazloomdoost D, Kleeman SD, Pauls RN. Comparative perioperative pain and recovery in women undergoing vaginal reconstruction versus robotic sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2017;23(2):95–100.CrossRefGoogle Scholar
  30. 30.
    Thomas TN, Siff LN, Jelovsek JE, Barber M. Surgical pain after transobturator and retropubic midurethral sling placement. Obstet Gynecol. 2017;130(1):118–25.CrossRefGoogle Scholar
  31. 31.
    Mostafa A, Lim CP, Hopper L, Madhuvrata P, Abdel-Fattah M. Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: an updated systematic review and meta-analysis of effectiveness and complications. Eur Urol. 2014;65(2):402–27.CrossRefGoogle Scholar
  32. 32.
    Schweitzer KJ, Milani AL, van Eijndhoven HWF, Gietelink DA, Hallensleben E, Cromheecke G-J, et al. Postoperative pain after adjustable single-incision or transobturator sling for incontinence: a randomized controlled trial. Obstet Gynecol. 2015;125(1):27–34.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Section of Urology and Renal TransplantationVirginia Mason Medical CenterSeattleUSA

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