Early Discontinuation of Opioid-Based Intravenous Patient-Controlled Analgesia After Single-Port Adnexal Laparoscopy: Incidence, Reasons, and Postoperative Outcomes.

Background/Objectives: Opioid-based intravenous patient-controlled analgesia (IV-PCA) provides postoperative analgesia but can cause adverse effects that lead to early discontinuation. In relatively limited procedures such as single-port access (SPA) adnexal laparoscopy, the balance between analgesic benefit and opioid-related adverse effects remains uncertain. We evaluated the frequency of and recorded reasons for early IV-PCA discontinuation, associated factors, postoperative pain, and length of stay. Methods: We retrospectively reviewed 431 patients who received IV-PCA after single-port access (SPA) adnexal laparoscopy at two institutions. Early discontinuation was defined as permanent cessation before completion of the planned course. Associations with demographic and operative factors, concurrent continuous wound infiltration, and treating institution were examined. Repeated-measures analysis accounted for discontinuation timing and repeated pain assessments. Results: IV-PCA was discontinued early in 13.9% of patients. Among patients who discontinued IV-PCA, 85.0% had nausea or vomiting recorded as the reason for discontinuation. Of 59 patients with valid timing data, 47 (79.7%) discontinued within 24 h. No measured factor was significantly associated with discontinuation after adjustment. Unadjusted mean pain scores were 0.30, 0.39, and 0.28 points higher at 6, 12, and 24 h, respectively, but these differences were not significant after correction for multiple comparisons. Repeated-measures analysis showed no overall pain difference (+0.09 points, 95% CI -0.21 to +0.39). A secondary analysis suggested variation over time, but no time-specific estimate was statistically significant. Length of stay was similar between groups. Conclusions: Early IV-PCA discontinuation after SPA adnexal laparoscopy was mainly attributed to nausea or vomiting. These findings do not establish whether opioid-based IV-PCA is necessary or should be avoided in this setting; rather, they highlight the need to balance its potential analgesic benefit against opioid-related adverse effects and to prospectively evaluate alternative multimodal analgesic strategies.