Postoperative pain after laparoscopic and vaginal hysterectomy for benign gynecologic disease: a randomized trial (original) (raw)
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BioMed research international, 2017
To evaluate influences of various factors on the types and intensity of postoperative pain following gynecologic laparoscopic surgery. Cross-sectional questionnaire and chart review. A total of 84 questionnaires were distributed and returned. The types of postlaparoscopic pain are different in multiparous women and nulliparous ones (71.43% surgical wound pain versus 63.64% nonsurgical wound pain, = 0.0033) and those with striae gravidarum and without striae gravidarum (93.94% surgical wound pain versus 52.94% nonsurgical wound pain, < 0.0001). On postoperative day 1, the average VAS score is higher in nonsurgical wound pain than in surgical wound pain (5.62 ± 1.50 versus 3.51 ± 1.68, < 0.0001). The CO removal procedure has a significant negative correlation with the VAS of nonsurgical wound pain (coefficient: -0.4339, = 0.0187). Our study suggests that women with abdominal rigidity (nulliparous, no striae gravidarum) experience mainly nonsurgical wound pain, while women with a...
Comparison of Laparoscopic and Abdominal Methods of Hysterectomy from Patient’s Perspective
Medical Science and Discovery, 2015
The aim of this study was to compare the postoperative pain and satisfaction of patients who underwent total laparoscopic or abdominal hysterectomy for benign gynecologic conditions. Materials and Methods: This study was a prospective, randomized trial. A visual analogue scale and patient satisfaction score scale were used to evaluate the patients' postoperative satisfaction rates. Seventy-one patients who underwent total laparoscopic hysterectomy were compared with 68 patients who underwent total abdominal hysterectomy for benign gynecologic indications. Results: The groups were similar with respect to age, race, gravidity and parity status, and uterine weight. Hospital stay; need for analgesic use; visual analogue scale pain scores at 12, 24, and 36 hours; patient satisfaction scores at 24 and 48 hours and one week; and blood loss were statistically lower in the laparoscopic hysterectomy group than in the abdominal hysterectomy group (p<0.001). Conclusion: Laparoscopic hysterectomy was superior to abdominal hysterectomy in terms of short-term followup, postoperative pain, and satisfaction with the operation scar.
2013
To evaluate the occurrence and intensity of cyclic pelvic pain and patient satisfaction after laparoscopic supracervical hysterectomy and to explore the effect of the procedure on pelvic pain relief in women with perioperative detection of endometriosis and in women with histologic confirmation of adenomyosis. Design: Prospective observational study with 12-month follow-up after laparoscopic supracervical hysterectomy (Canadian Task Force classification II-2). Setting: University teaching hospital in Norway. Patients: One hundred thirteen premenopausal women with preoperative cyclic pelvic pain treated via laparoscopic supracervical hysterectomy. Interventions: Study participants underwent laparoscopic supracervical hysterectomy and were followed up at the outpatient clinic at 12 months after the procedure. Measurements and Main Results: The main outcomes were occurrence, intensity, and reduction of cyclic pelvic pain and patient satisfaction measured using an ordinal and a visual analog scale at 12 months after the procedure. Of the 113 women included in the study, 8 were lost to follow-up. Consequently, 105 women (92.9%) were followed up at 12 months after surgery. All women had cyclic pelvic pain preoperatively, but only 34 (32.4%) experienced this pain at 12 months after the procedure. The intensity of pelvic pain was reduced from a mean (SD) of 5.5 (2.4) preoperatively to 0.7 (1.5) at 12 months after the procedure on a visual analog scale of 0 to 10 (p , .01). Endometriosis was diagnosed perioperatively in 14 women (12.4 %), and adenomyosis was confirmed at histologic analysis in 19 (18.1%). In women with perioperative detection of endometriosis or histologic confirmation of adenomyosis, there were no significant differences in main outcomes at 12 months after laparoscopic supracervical hysterectomy when compared with women without these diagnoses. Conclusion: Laparoscopic supracervical hysterectomy is associated with high patient satisfaction and reduces cyclic pelvic pain to a minimum by 12 months after the procedure.
Acta Obstetricia et Gynecologica Scandinavica, 2011
Objective. To determine whether postoperative symptoms differ between women who undergo abdominal benign hysterectomy in a fast‐track model under general anesthesia or spinal anesthesia with intrathecal morphine. Design. Secondary analysis from a randomized, open, multicenter study. Setting. Five hospitals in south‐east Sweden. Population. One‐hundred and eighty women scheduled for benign hysterectomy were randomized; 162 completed the study; 82 were allocated to spinal and 80 to general anesthesia. Methods. The Swedish Postoperative Symptoms Questionnaire, completed daily for 1 week and thereafter once a week until 5 weeks postoperatively. Main Outcome Measures. Occurrence, intensity and duration of postoperative symptoms. Results. Women who had hysterectomy under spinal anesthesia with intrathecal morphine experienced significantly less discomfort postoperatively compared with those who had the operation under general anesthesia. Spinal anesthesia reduced the need for opioids post...
Scientific Reports
Effective perioperative pain management is essential for optimal patient recovery after surgery and reduces the risk of chronification. However, in clinical practice, perioperative analgesic treatment still needs to be improved and data availability for evidence-based procedure specific analgesic recommendations is insufficient. We aimed to identify procedures related with high pain scores, to evaluate the effect of higher pain intensity on patients and to define patient and intervention related risk factors for increased pain after standard gynaecological and obstetrical surgery. Therefore, we performed a prospective cross-sectional study based on the German registry for quality in postoperative pain (QUIPS). A cohort of 2508 patients receiving surgery between January 2011 and February 2016 in our tertiary referral centre (university departments of gynaecology and obstetrics, respectively) answered a validated pain questionnaire on the first postoperative day. Maximal pain intensit...
Trials, 2013
Background: Non-randomised studies have suggested that the postoperative complications of (Campos LS, Limberger LF, Stein AT, Kalil AN) laparoscopic radical hysterectomy are similar to those in abdominal radical hysterectomy. However, no study evaluating postoperative pain comparing both techniques has been published thus far. Our objective was to compare pain intensity and other perioperative outcomes between laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) in early cervical cancer. Methods: This single centre, randomised, controlled trial enrolled 30 cervical cancer patients who were clinically staged IA2 with lymph vascular invasion and IB according to the FIGO (International Federation of Gynaecology and Obstetrics) classification, and underwent LRH or ARH between late 1999 and early 2004. Postoperative pain, as measured by a 10-point numerical rate scale, was considered the primary endpoint. Postoperative pain was assessed every six hours during a patient's usual postoperative care. Perioperative outcomes were also registered. Both surgical techniques were executed by the same surgical team. Secondary outcomes included intraoperative and other postoperative surgicopathological factors and 5-year survival rates. Results: IA2 patients with lymphatic vascular space invasion and IB cervical cancer patients were randomised to either the LRH group (16 patients) or the ARH group (14 patients). Four patients (25%) in the LRH group and 5 patients (36%) in the ARH group presented with transoperative or serious postoperative complications. All of the transoperative complications occurred in the LRH group. The relative risk of presenting with complications was 0.70; CI 95% (0.23-2.11); P = 0.694. LRH group mean pain score was significantly lower than ARH after 36 h of observation (P = 0.044; mean difference score: 1.42; 95% CI: 0.04-2.80). The survival results will be published elsewhere. Conclusions: LRH provided lower pain scores after 36 h of observation in this series. The perioperative and serious postoperative complications ratios were comparable between the groups. Trial Registration: NCT01258413
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2007
To determine patient satisfaction with postoperative pain control after ambulatory gynaecologic laparoscopic surgery. A prospective cohort study in a major tertiary care centre was performed to assess patient satisfaction with postoperative analgesia on the day of surgery and on postoperative days one and two. Data were collected either by telephone or mail-in questionnaire on each postoperative day. Each patient rated her level of satisfaction according to a 5-point scale at the end of each postoperative day as an average for that day. The final outcome was recorded as either satisfied, with all days classified as "very satisfied" or "perfectly satisfied," or unsatisfied, if any single day was rated as "not satisfied at all," "only slightly satisfied," or "somewhat or partly satisfied." Forty-nine patients completed the questionnaire. Surgical procedures included tubal ligation with cautery (20), ovarian cystectomy (5), oophorectomy...
Journal of women's health , 2018
The study objective was to analyze and compare patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) after hysterectomy in women with and without a preoperative complaint of pelvic pain associated with and without a confirmed diagnosis of endometriosis. Retrospective nationwide register study. Data on 28,776 hysterectomies performed on benign indication between 2004 and 2016 were retrieved from the Swedish National Register for Gynecological Surgery. Multivariable logistic regression models were used to compare the PREMs and PROMs items. The results are presented as adjusted odds ratios (aORs) and 95% confidence intervals (CI). Regardless of the occurrence of pelvic pain preoperatively and a diagnosis of endometriosis, 1 year after surgery, the women were satisfied or very satisfied (>90%) with the hysterectomy, and their medical condition was improved or much improved (>95%). The women with a preoperative complaint of pelvic pain and endom...