Does a Non-Opioid Multimodal Pain (NOMO) Protocol Decrease Narcotic Use

The objective of this study is to evaluate narcotic use after implementation of a Non-Opioid Multimodal Pain (NOMO) protocol in patients who are undergoing a urogynecologic procedure. NOMO protocols seek to reduce the opioid usage for patients in the postoperative period. Patients will receive multiple pain medications (usually referred to as a "pain cocktail") that work on various pain receptors throughout the body. These medications are approved for pain control; but they have few side effects and less addictive properties. The study will also evaluate secondary outcomes, including: post-operative pain rating, length of hospital stay, postoperative antiemetic use, bladder catheterization at discharge, number of post-operative phone calls, and rate of reported side effects of opioid use (nausea/constipation). Study participants will be asked to utilize the validated Brief Pain Inventory (appendix A) scale to assess post-operative pain levels. Based on inpatient post-operative opioid use and number of opioid pills prescribed at discharge, an attempt will be made to develop an algorithm for recommended opioid prescribing patterns.

Inclusion criteria

• English-speaking females
• greater than or equal to 18 years old
• scheduled for a urogynecologic procedure at GHS requiring inpatient stay or extended observation.

Exclusion criteria

• less than 18 years of age
• non-English speaking patients
• unscheduled urogynecologic surgeries
• patients expected to undergo a simple reconstructive surgery with same-day discharge,
• history of chronic pain
• chronic Lyrica or Celebrex use
• psychiatric disorder, narcotic dependence or narcotic prescription in the past six weeks
• current liver disease
• kidney disease (defined as GFR <60)
• malignancy
• sulfa allergy