(011) Using Pre-Operative Low Intensity Vestibular Shockwave Therapy Reduces Opioid Use Post-Vestibulectomy
Authors: Stearns H , Uloko M , Gagnon C , Goldstein I 
Published: June 2023

Abstract

Introduction
Surgeons performing complete vestibulectomy for neuro-proliferative vestibulodynia need to consider two competing post-operative interests: accomplishing acute pain relief in the early postoperative period; reducing risks of persistent post-operative opioid use. Data support that measures to decrease overall post-operative opioid use will decrease future opioid-related adverse events including opioid abuse and addiction. Sexual medicine providers are thus motivated to identify strategies such as pre-operative low intensity shockwave therapy (LISWT) to decrease opioid use in these vestibulectomy patients. To date, only one study has been published assessing the effect of pre-operative LISWT on surgical outcome. Dumfarth at al reported in a prospective randomized study that pre-operative LISWT significantly improved lower extremity wound healing compared to controls in patients undergoing vein harvesting for coronary artery bypass graft surgery. While Dumfarth et al did not directly assess post-operative pain, pre-operative LISWT was associated with statistically significantly increased satisfactory healing, reduced disturbance of healing and reduced minor skin infections, all consistent with less post-operative pain. It was hypothesized that pre-operative LISWT improved wound healing via enhanced blood supply and angiogenesis through expression of vascular endothelial growth factor (VEGF) and nitric oxide synthesis, and via anti-inflammatory action downregulating necrosis factor B activation thereby lowering inflammatory cytokines.

Objectives
We wished to see if pre-operative LISWT would reduce opioid use in women undergoing complete vestibulectomy. The objective of this study was to compare the use of opioids following vestibulectomy when LISWT with Urogold 100™ MTS was applied just prior to surgery versus no shockwave. LISWT is a non-invasive, non-pharmacologic, non-surgical treatment strategy with low morbidity that is FDA-cleared for pain amelioration in the US as non-significant risk in humans, Urogold 100™MTS provides unfocused electrohydraulic shockwaves with a unique parabolic reflector.

Methods
Patients scheduled for surgery were required to present to the hospital 4 days before surgery for a COVID-19 test. On that day and each subsequent day until surgery, based on the patient’s availability, the patient presented to the office for approximately 2400 shocks to the vestibule. This is a descriptive study of the patients’ post-operative experiences with pain.

Results
To date 4 women have undergone LISWT just prior to surgery. At the time of surgery Exparel was delivered to the site, allowing them 24-36 hours of anesthesia to the area so they could travel home easily. Patients were prescribed Percocet to be take every 4 hours as needed. Post-op patients routinely use this opioid 4-6 times a day for multiple days, causing constipation among the many side effects. The women who underwent LISWT immediately prior to surgery have experienced decreased levels of pain post-operatively such that they are using ½ tab of Percocet at bedtime or twice a day, thus decreasing opioid use with all of its potential side effects.

Conclusions
Performing LISWT using Urogold 100™MTS may reduce the need for opioid medications after total vestibulectomy with vaginal advancement flap as it may mediate pain after the surgical procedure.

Disclosure
No.