Introduction: We observed at our hospital that patients were using more opioids postoperatively than reported in the literature. We evaluated the efficacy of adding suzetrigine preoperatively to our enhanced recovery after surgery (ERAS) protocol, which utilizes premedication (acetaminophen, celecoxib, and pregabalin), then intraoperative subcutaneous liposomal bupivacaine followed by scheduled oral acetaminophen and ibuprofen postoperatively. Patients also have oxycodone as needed for breakthrough pain. The goal of this quality improvement project was to reduce postoperative opioid use at our hospital by 50 percent.

Materials and Methods: We conducted an ambispective quality improvement project that included all patients who underwent total laparoscopic hysterectomy over a 1-year period. We then added suzetrigine to the other routine premedications. 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.

Results: 68 patients were included within the preintervention and after-intervention cohorts. Mean opioid usage was lower in the post-intervention group (13.3mg versus 28.5mg, p<0.001). After intervention, patients were five times more likely to decline opioids (p<0.001) without any concomitant increase in pain scores. Furthermore, after the intervention, patients were 24 times more likely to be discharged on the day of surgery (p<0.001).

Discussion: The addition of suzetrigine to our ERAS protocol was associated with significant reductions in postoperative opioid use and mean pain scores. The quality improvement project met its stated goal of reducing postoperative opioid use by 50 percent.

Kevin White is an obstetrician-gynecologist in Ruston, Louisiana. He received his medical degree from the University of Kentucky College of Medicine and has been in practice for between 11 and 20 years.