Use of a Dual-Agent Local Analgesic (Bupivacaine-Meloxicam) in Patients Undergoing Retropubic Sub-Urethral Sling Surgery. A Randomized Controlled Trial

INTRODUCTION: Retropubic sub-urethral slings for stress urinary incontinence are minimally invasive, yet narcotic use is common. Local analgesics may reduce the burden of narcotic use following this surgery. OBJECTIVE: The aim was to determine if use of bupivacaine-meloxicam (Zynrelef) reduces narcotic use in the first three days after surgery. Secondary aims were to compare average and worst pain, satisfaction with pain control, and quality of recovery between groups. METHODS: This was a single-center, prospective, single-blinded randomized controlled trial for women undergoing retropubic sub-urethral sling surgery. The study group received bupivacaine-meloxicam at the suprapubic sites, while controls received nothing additional. Discharge medication dosages and quantities were standardized. Subjects reported pain levels, medication use, satisfaction with pain control, and Quality of Recovery (QoR-15) surveys for the study period. Narcotic use was quantified using morphine milligram equivalents (MME). Appropriate statistical analyses were applied. RESULTS: A total of 119 women were randomized (Table 1). Median MME from postoperative day 0 to 3 in the control group was 37.5 MME compared to 30 MME in the bupivacaine-meloxicam group (p=0.61) (Table 2). Pain scores were low in both groups, and all subjects were satisfied or very satisfied with pain control. Quality of recovery scores were also similar, with return to near baseline by postoperative day 3. Subjects with depression/anxiety had higher oxycodone use (Table 3). CONCLUSIONS: The use of bupivacaine-meloxicam did not reduce narcotic use in the first 3 days following retropubic sling surgery. Despite this, it was reassuring that few narcotics were required overall.