Novel Multimodal Pain Control Protocol for Minimally Invasive Gynecologic Surgery

Pain scores on Day 2, 3, and 4: An NRS-11 pain score at rest will be collected on Day 2, 3, and 4 via electronic REDCap survey. A score of zero will correspond with "no pain" and a score of 10 corresponds with "worst possible pain."

Participants will be asked to complete a validated quality of recovery questionnaire (the QoR-40) on Day 1 in AM as part of their Day 1 study survey that will be administered electronically directly into REDCap. The QoR-40 will also be administered on Day 4 via electronic REDCap survey. QoR-40 scores range from 40 (extremely poor quality of recovery) to 200 (excellent quality of recovery).

Participants will be asked to rate their post-operative pain control satisfaction using an NRS-11 scale for satisfaction. The question prompt on Day 1 will read "On a scale of 0 to 10 how would you rate your satisfaction with your postoperative pain control in the last 24 hours?" A score of 0 corresponds with "very dissatisfied" and a score of 10 corresponds with "very satisfied." A pain control satisfaction NRS-11 will also be administered on Day 4 as part of the electronic REDCap survey. The question prompt on Day 4 will read "On a scale of 0 to 10 how would you rate your satisfaction with your postoperative pain control since you left the hospital?"

Patient satisfaction with the scheduled 24 hour ice therapy will be assessed using the same NRS-11 satisfaction scale as described above. Ice therapy satisfaction will be assessed on Day 1 as part of the Day 1 AM REDCap survey to be administered electronically directly into REDCap. The question prompt with the NRS-11 will read "On a scale from 0 to 10, how would you rate your satisfaction with the ice therapy as part of your postoperative pain regimen?" A score of 0 corresponds with "very dissatisfied" and a score of 10 corresponds with "very satisfied." We will also ask the following non-validated questions aimed at assessing patient satisfaction with their ice therapy: "Did you feel that the ice therapy was helpful? Did you feel that the ice therapy was bothersome? If you had to do it over, would you use the ice therapy again?" These same questions will be administered as part of the Day 4 electronic REDCap survey.

Patient satisfaction with the scheduled 24 hour ice therapy will also be assessed by asking a brief questionnaire including the following non-validated questions: "Did you feel that the ice therapy was helpful? Did you feel that the ice therapy was bothersome? If you had to do it over, would you use the ice therapy again?" The answer options will be "yes" or "no". These same questions will be administered as part of the Day 4 electronic REDCap survey.

Administration or use of any opioids will be extracted from the medical record and recorded in the study database for the pre-operative, intraoperative, immediate post-operative (i.e. PACU), and inpatient time points. Any use of intravenous opioids will be specifically noted in study database. Once discharged from the hospital, participants will be asked to fill out a daily pain control and medication use electronic survey on Day 2, 3, and 4. The brief survey will have fields for frequency and dosage in milligrams of opioid use over the past 24 hours. All opioid information will be converted into oral morphine equivalents using an equianalgesic dosage conversion calculator.

Administration or use of acetaminophen will be extracted from the medical record and recorded in the study database for the pre-operative, intraoperative, immediate post-operative (i.e. PACU), and inpatient time points. Once discharged from the hospital, participants will be asked to fill out a daily pain control and medication use electronic survey on Day 2, 3, and 4. The brief survey will have a field for frequency of acetaminophen use with the ability to select from the following options: "every 4 hours, every 6 hours, every 8 hours, twice a day, once a day, or other".

Administration or use of acetaminophen will be extracted from the medical record and recorded in the study database for the pre-operative, intraoperative, immediate post-operative (i.e. PACU), and inpatient time points. Once discharged from the hospital, participants will be asked to fill out a daily pain control and medication use electronic survey on Day 2, 3, and 4. The brief survey will ask dosage of acetaminophen use measured in milligrams over the past 24 hours.

Administration or use of any NSAID will be extracted from the medical record and recorded in the study database for the pre-operative, intraoperative, immediate post-operative (i.e. PACU), and inpatient time points. Once discharged from the hospital, participants will be asked to fill out a daily pain control and medication use electronic survey on Day 2, 3, and 4. The brief survey will have a field for frequency of NSAID use with the ability to select from the following options: "every 4 hours, every 6 hours, every 8 hours, twice a day, once a day, or other".

Administration or use of any NSAID will be extracted from the medical record and recorded in the study database for the pre-operative, intraoperative, immediate post-operative (i.e. PACU), and inpatient time points. Once discharged from the hospital, participants will be asked to fill out a daily pain control and medication use electronic survey on Day 2, 3, and 4. The brief survey will ask dosage of NSAID use measured in milligrams over the past 24 hours.

Administration or use of any other neuraxial agent or medication for pain (i.e. gabapentin) will be extracted from the medical record and recorded in the study database for the pre-operative, intraoperative, immediate post-operative (i.e. PACU), and inpatient time points. Once discharged from the hospital, participants will be asked to fill out a daily pain control and medication use electronic survey on Day 2, 3, and 4. The brief survey will have a "free text" field to allow the participant to describe any use of a medication for pain not listed above.

Administration or use of ice therapy will be extracted from the nurse ice administration logs. This will be recorded in the study database for the pre-operative, intraoperative, immediate post-operative (i.e. PACU), and inpatient time points. Once discharged from the hospital, participants will be asked to fill out a daily pain control and medication use electronic survey on Day 2, 3, and 4. The brief survey will have fields for frequency of ice therapy with the ability to select from the following options: "every 1-2 hours, every 2-3 hours, every 3-4 hours, every 4-5 hours, every 5-6 hours, every 6-8 hours, every 8-12 hours, or once".

After Day 30, a study investigator will perform a chart review and an OARRS (Ohio automated Rx reporting system) report on each participant in order to complete the secondary outcomes of 30-day post-operative complications, unexpected office phone calls or visits, emergency room visits, readmissions, and medication refill requests.

Throughout the study we will monitor for AEs, both anticipated and unanticipated. Possible AEs for scheduled ice therapy could include local discomfort, skin irritation, or ice burn if used incorrectly without a barrier between ice therapy and skin. Ice therapy side effects or AEs will be directly queried on Day 1 by study investigator, and on Day 2, 3, and 4 via electronic survey. All AEs will be reported to The Ohio State IRB according to the reporting guidelines. AEs will be assessed at each clinical/research visit and reported with study outcomes.