Although pelvic rehabilitation therapists are not directly involved in decision-making related to pharmacological pain management, knowledge of procedures and practice patterns related to perioperative pain management may be useful in communicating with the medical team and in understanding a patient's pain experiences related to surgery. A review article published in Female Pelvic Medicine & Reconstructive Surgery highlights the pain management strategies described in the literature that are relevant for urogynecologic surgery. Brief descriptions of the preoperative, intraoperative, and postoperative pain control strategies are discussed in this study, and the following recommendations are made:
-Multimodal analgesic approaches should be considered for all procedures because the use of several interventions (with varied mechanisms of action) can reduce postoperative pain, reduce opioid use and opioid-related side effects. Medications for potential use in a multimodal approach include perioperative paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), dexamethasone, and local anesthetics.
-For patients having abdominal urogynecologic procedures, bilateral TAP blocks are recommended. A TAP block is short for transversus abdominis plane block, and aims to numb the sensory afferent nerves of the anterior abdominal wall running superficial to the transversus abdominis muscle. For the procedure, a needle is placed into the area created within the margins of the superior iliac crest, the latissimus dorsi muscle, and the external oblique muscle. The needle placement can be done by palpation or with ultrasound guidance.