SAN DIEGO – Gynecologic surgery patients at the highest risk for postoperative complications who wore an abdominopelvic compression binder for 24 hours after surgery had significantly improved ambulation compared with those who did not wear the binder, results from a randomized trial showed.
"The goals of postoperative pain management include early return of normal functions and minimal impact on ambulation," Dr. James Brian Szender said at the annual meeting of the American College of Obstetricians and Gynecologists. "Strategies that decrease morphine use, while at the same time increasing ambulation, have the potential to decrease postoperative pneumonia, prevent thromboembolic events, and lessen postoperative ileus."
Courtesy Dr. James Brian Szender
Dr. James Brian Szender
Dr. Szender, a third-year resident in the department of obstetrics and gynecology at the University of Texas, and his associates at the Brooke Army Medical Center, both in San Antonio, enrolled 75 patients in a randomized trial to determine the impact of a neoprene abdominopelvic binder on postoperative morphine use, pain, and ambulation in the first 24 hours after abdominal gynecologic surgery. The binder is made by GemTech Medical and is known as the Mott compression garment. Patients were excluded from the study if they received an epidural injection, ketorolac, or oral analgesia, or if they were allergic to morphine.
The binder, which varies in size and retails for about $125, was placed on patients in the OR and remained in place until 24 hours after surgery. It is believed to reduce shear forces at the surgical incision, thereby causing less discomfort when the patient sits, stands, or walks. Patients received a standardized morphine regimen for the first 24 hours; study variables (including age, weight, incision type, total morphine use, postoperative pain score, and total number of ambulatory events) were collected after 24 hours.
Of the 75 patients, 36 received binders and 39 did not. The mean age of the study participants was 45 years and their mean weight was 78 kg. Spearman rank correlation identified a group of patients at high risk for decreased ambulation: those with vertical skin incisions, those older than age 50, and those with gynecologic cancer.
Dr. Szender reported that compared with nonuse of the compression binder, use of the binder increased the number of ambulatory events in the first 24 hours after surgery by 200% in patients with vertical skin incisions, by 150% in those older than age 50, and by 74% in those who had undergone surgery for gynecologic cancer. The researchers observed no statistically significant differences between the two groups in the amount of morphine used or in pain scores. However, "when patient variables were stratified by age, older patients used less morphine, had lower pain, got up earlier, and walked more when they had the binder on," Dr. Szender said.
He added that the binders "were liked [and] well tolerated, and patient compliance was 100%."
GemTech Medical provided the binders used in the study. Dr. Szender said that he had no relevant financial conflicts to disclose.