Superior Hypogastric Nerve Block

Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 Gynaecologists (LaSGeG), Sydney, NSW, Australia; 6Obstetrics and Gynaecology, Campbelltown Private Hospital, Sydney, NSW, Australia; 7 Obstetrics and Gynaecology, North Shore Private Hospital, Sydney, NSW, Australia; 8Obstetrics and Gynaecology, St Luke’s Private Hospital, Sydney, NSW, Australia *Corresponding author. Study Objective: We aimed to evaluate the diagnostic accuracy of deep endometriosis transvaginal ultrasound (DE TVS) in predicting a surgically-apportioned ASRM endometriosis stage. Design: Multicenter retrospective diagnostic accuracy study. Setting: Patients attended one of two gynecology-focused ultrasound practices and underwent laparoscopy by one of six surgeons in the Sydney metropolitan area between 2016 and 2018. Patients or Participants: Patients with suspected endometriosis. Interventions: DE TVS followed by laparoscopy. Measurements and Main Results: An ASRM stage was apportioned to each patient based on the surgical report. An ultrasound-based ASRM stage was also apportioned using the preoperative DE TVS report. Where details on size of lesions was missing, the range of possible points for that region was used to calculate a minimum and maximum ASRM stage. The diagnostic accuracy (accuracy, sensitivity, specificity, positive predictive value, negative predictive value and positive and negative likelihood ratios) was calculated for each ASRM stage and dichotomized ASRM stages (0/1/2 and 3/4) at the minimal and maximum ASRM stages. An advanced ASRM stage, called ASRM +, was allocated when rectal, vaginal, or ureteral endometriosis was noted and combined with the base ASRM stage (1-4). 204 patients were included. The breakdown of surgical findings is as follows: normal (i.e. no endometriosis, referred to as ASRM 0) 24/ 204 (11.8%), ASRM 1 110-127/204 (53.9-62.3%), ASRM 2 8-22/204 (3.9-10.8%), ASRM 3 15-16/204(7.4-7.8%), ASRM 4 30-32/204 (14.7-15.7%). Overall, DE TVS had better test performance in higher disease stages. When the ASRM stages are dichotomized, DE TVS has sensitivity/specificity for ASRM 3/4 of 96.2%/93.4% and ASRM 0/1/2 of 94.9%/93.8%. Conclusion: Ultrasound has excellent test performance in predicting a dichotomized ASRM stage state, which can have major positive implications on patient triaging to centers of excellence in minimally-invasive gynecology for advanced stage endometriosis. This may have a downstream positive effect on patient outcomes. Open Communications 18: Endometriosis (2:15 PM − 3:00 PM) 2:29 PM Associations Between Preoperative Depression, Hysterectomy, and Postoperative Opioid Use Carey ET,1,* Strassle PD,2 Moore KJ,2 Schiff LD,1 Louie M1. 1Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC; 2 Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC *Corresponding author. Study Objective: Preoperative depression has been linked to adverse outcomes following hysterectomy, including increased acute and chronic postoperative pain. The goal of this study was to determine whether preoperative depression is associated with increased opioid use following hysterectomy. Design: Retrospective analysis of women who underwent benign hysterectomy between January 2001 and March 2015. Women without opioid prescriptions 180 days prior to surgery were identified in IBM Watson/ Truven Health Analytics MarketScanÒ database, a large claims database and were required to have continuous enrollment in one of these health plans for 180 days before and after hysterectomy. Persistent opioid use was defined as an opioid fill during the perioperative period (10 days

S71 before to 30 days after surgery) and an additional opioid fill 90-180 days after hysterectomy. Setting: N/A Patients or Participants: 531,059 women who underwent hysterectomy for non-cancer causes during the study period; 72% (n=383,243) were opioid naı¨ve and included. Interventions: N/A Measurements and Main Results: Multivariable log-binomial regression was used to assess whether women with preoperative depression had a higher risk of persistent opioid use and 30-day complications, after adjusting for demographics, comorbidities, and surgical characteristics. The prevalence of pre-surgical depression was 20% (n=75,230). 74% of women were given an opioid prescription during the perioperative period and, of those that initiated, 8% had at least one additional opioid fill 90-180 days after their hysterectomy. After adjustment, women with depression were only 8% more likely to get an initial opioid fill (RR 1.08, 9%%CI 1.07, 1.08) but were 43% more likely to have persistent opioid use (RR 1.43, 95% CI 1.39, 1.47). Women with depression were also more likely to have any surgical complication (RR 1.04, 95% CI 1.03, 1.06). Conclusion: In our cohort, women with preexisting depression had a greater risk of persistent opioid use post-hysterectomy suggesting chronic pain beyond the immediate recovery period and potentially increased risk of opioid dependence.

Open Communications 18: Endometriosis (2:15 PM − 3:00 PM) 2:36 PM Superior Hypogastric Nerve Block Sims MJ,* Hammons LM. Western Pennsylvania Hospital, Pittsburgh, PA *Corresponding author. Video Objective: To introduce a presacral nerve block for regional anesthesia in the pelvis. Setting: Selected for patients with midline pelvic pain, endometriosis, and dysmenorrhea. The context of these procedures is in a high volume benign minimally invasive gynecologic surgery service with a single advanced laparoscopic surgeon at two hospitals within a health care system in an urban setting. The block is performed as part of an ERAS protocol for patients undergoing elective surgery with the outlined indications. Interventions: The authors elected to modify the presacral neurectomy from a permanent transection of the superior hypogastric nerve plexus to a temporary medical neurectomy as a regional block. The block is a component of the regional anesthesia plan within a standardized ERAS protocol. The anesthesia solution used for the block is 10 cc of 0.5% bupivacaine with 1:200,000 epinephrine mixed with 10mg dexamethasone. Conclusion: Given the ease in performing the nerve block, the historical context of the presacral neurectomy amongst gynecologic surgeons who care for chronic pelvic pain, the progress being made in ERAS protocols for gynecologic surgery services, and the extremely promising anecdotal experiencing for our institution, further study of this technique is warranted.

Open Communications 18: Endometriosis (2:15 PM − 3:00 PM) 2:43 PM Profiling of Mirna and Mrna in Eutopic and Ectopic Endometrial Tissues in Patients with Endometrioma Filippova ES,* Gamisoniya AM, El’darov CM, Trofimov D, Kazachenko I.F, Bobrov M, Adamyan L.V.V.I. Kulakov National Medical