Browsing by Author "Patanwala, Insiyyah"

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    Opioid Prescription Usage after Benign Gynecologic Surgery: A Prospective Cohort Study
    (Elsevier, 2019) Patanwala, Insiyyah; Ouyang, Chensi; Fisk, Matthew; Lamvu, Georgine; Obstetrics and Gynecology, School of Medicine
    Study Objective To compare the amount of opioids (tablets and morphine milligram equivalents [MMEs]) prescribed by physicians and used by patients after benign gynecologic surgery. Design Prospective cohort study. Setting Tertiary center: main hospital operating room and outpatient surgery center. Patients Women undergoing benign gynecologic surgery. Interventions Major and minor gynecologic surgeries. Measurements and Main Results The surgery groups were minor laparoscopy (Minor), major minimally invasive (Major), and laparotomy (Laparotomy). Demographic, medical, and surgical data were abstracted from electronic medical records. On postoperative day (POD) 7, women completed a telephone survey describing pain levels, prescription use, and satisfaction with pain control. Patients who continued to use opioids for pain relief were surveyed on POD 14. If use continued, patients were surveyed again on POD 28. The primary outcome was amount of opioid prescribed compared with opioid used. Of 193 screened participants 172 were enrolled (89%), and data were analyzed for 154 (90%): 59 (38%) Major, 71 (56%) Minor, and 24 (16%) Laparotomy. The median number of tablets and MMEs prescribed was lowest for the Minor group (Minor, 24 tablets; Major, 30 tablets; Laparotomy, 30 tablets [p <.01]; Minor, 150 MMEs; Major, 225 MMEs; Laparotomy, 225 MMEs [p = .01]). We found no difference in the number of tablets (Minor, 8; Major, 8; Laparotomy, 9; p = .77) or MMEs used (Minor, 45 MMEs; Major, 45 MMEs; Laparotomy, 55 MME; p = .81) between the groups. On POD 7 there was no difference in median numerical rating scale pain scores (Minor, 3; Major, 2; Laparotomy, 2; p = .07) or satisfaction with analgesia on POD 7 (p = .44), 14 (p = .87), and 28 (p = .18). Patients with prior chronic pain used more total amounts of opioids (68 MME vs 30 MME, p <.01) and were more likely to require opioid refill (odds ratio, 10.4; 95% confidence interval, 1.3–83.6) compared with those without a similar history. Conclusion In this cohort, gynecologic surgeons prescribed nearly 3 times more opioid tablets and MMEs than was used by patients despite patients reporting similar levels of pain after minor and major surgeries.
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    Transversus abdominis plane (TAP) blocks for prevention of postoperative pain in women undergoing laparoscopic and robotic gynaecological surgery
    (Cochrane Library, 2022-11-21) Pickett, Charlotte; Patanwala, Insiyyah; Kasper, Kelly; Haas, David M.; Obstetrics and Gynecology, School of Medicine
    Objective: We sought to determine the effect of a subcostal transversus abdominis plane (TAP) block with liposomal bupivacaine on postoperative maximal pain score and length of hospital stay among women undergoing robotic-assisted hysterectomy. Methods: This was a retrospective study comparing patients before and after consistent implementation of TAP blocks with liposomal bupivacaine during robotic-assisted hysterectomies at a single academic institution. Analysis compared patient demographic and operative characteristics by TAP block use, along with outcomes of interest, including postoperative pain and length of hospital stay. Results: There was a statistically significant decrease in maximal numerical rating scale pain scores, presence of nausea and vomiting, and length of hospital stay in those who had a TAP block with liposomal bupivacaine compared with those who did not receive a TAP block. These differences remained even after adjustment for potential confounders. Conclusions: In this retrospective study, liposomal bupivacaine used in a TAP block was a useful method to provide postoperative pain control in patients undergoing robotic-assisted hysterectomy and was associated with lower postoperative maximal pain scores and length of hospital stay.
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    Treatment for Pelvic Floor Myalgia and Myofascial Pelvic Pain: A Systematic Review
    (2021-10-22) Higgins, Olivia M.; Asdell, Stephanie; Stumpff, Julia C.; Patanwala, Insiyyah
    Introduction Pelvic floor myalgia is characterized by muscular tension, tenderness and trigger points of the pelvic floor muscles and connective tissue. Its prevalence varies from 14-78%. Our aim was to review treatment interventions for adult women with pelvic floor myalgia Methods A systematic review of prospective trials was conducted in MEDLINE (Ovid/PubMed), EMBASE, Cochrane Library, Scopus, Web of Science, ClinicalTrials.gov. Studies published up until March 2020 were included. After duplicates were removed, 7,711 studies were screened and 992 full texts were reviewed for final inclusion of randomized control trials (RCT) only. To meet inclusion criteria, study participants needed to have pelvic floor myalgia, hypertonicity or pain determined by a physical exam. All interventions were included. Results After final data extraction, 18 studies met inclusion criteria, which included 1043 participants. Most studied interventions were pelvic floor physical therapy (4 studies, 218 participants) and pelvic floor botulinum A toxin injections (4 studies, 281 participants). Other interventions included vaginal diazepam (3 studies, 112 participants), oral desipramine/local lidocaine (1 study, 133 participants), cognitive behavioral therapy (1 study, 117 participants), hypnotherapy (1 study, 36 participants), local anesthetic trigger point injections (1 study, 29 participants), and oxytocin nasal spray (1 study, 21 participants). Conclusions Many studies showed a placebo effect possibly indicating that simple acknowledgement of pain symptoms with a treatment plan can improve pain. Physical therapy showed significant improvement in pain and sexual functioning compared to controls. Botulinum toxin A was not proven to be beneficial for pelvic floor myalgia and hypertonicity