Opioids are commonly prescribed for postoperative pain control after gynecologic surgeries, but many prescribed opioids often go unused, raising concerns about misuse. Restrictive opioid prescribing has proven effective in other surgical specialties, but its impact on urogynecologic surgeries remains unclear. Adequate pain control is critical for recovery and outcomes following prolapse and incontinence surgeries. However, routine opioid use carries risks such as dependence, adverse effects, and delayed recovery. Restrictive prescribing strategies aim to minimize opioid use while ensuring adequate pain control and addressing complications related to overprescription. This study hypothesizes that restrictive opioid prescribing offers similar pain control and satisfaction as routine prescribing, with reduced opioid use. The aim is to assess the effectiveness of restrictive versus routine prescribing regarding pain, satisfaction, and healthcare utilization.

A systematic review of randomized controlled trials was conducted to compare restrictive versus routine opioid prescribing after prolapse and incontinence surgeries. Searches were performed in MEDLINE, EMBASE, CENTRAL, Scopus, Web of Science, and ClinicalTrials.gov up to January 2025. Two independent reviewers screened and selected studies, and data were extracted on pain scores, opioid consumption, patient satisfaction, prescribing practices, and healthcare utilization. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0.

This systematic review of six randomized controlled trials with a total of 922 patients found that restrictive opioid prescribing achieved pain control and patient satisfaction comparable to routine prescribing. No significant differences in satisfaction rates were observed (p > 0.05), nor was there a notable impact on healthcare utilization. However, the implementation of restrictive protocols led to a significant reduction in opioid consumption (p < 0.01). Requests for additional prescriptions were minimal and slightly more frequent in the restrictive groups. Multimodal analgesia ensured effective pain management, supporting restrictive prescribing as a safe and effective strategy to minimize opioid use.

Restrictive opioid prescribing resulted in significantly lower opioid consumption without compromising pain control or patient satisfaction. Minimal requests for additional pain medication and stable healthcare utilization suggest that restrictive protocols are both safe and effective. Multimodal analgesia played a key role in maintaining adequate pain relief.

Restrictive opioid prescribing is a safe and effective alternative to routine use following prolapse and incontinence surgeries. It maintains patient satisfaction and pain control while reducing opioid use and potential misuse.