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Less postoperative pain after laparoscopic hysterectomy than after vaginal hysterectomy

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To find out whether the severity of acute postoperative pain differs between laparoscopic (LH) or laparoscopically assisted vaginal hysterectomy (LAVH) and vaginal hysterectomy.

Methods

In a prospective, powered, non-randomized trial, the consumption of oxycodone and pain scores were evaluated in 164 women up to 20 h after VH or LH/LAVH. All hysterectomies were performed under standardized general anesthesia and the pain medication was similar in both groups. The primary endpoint was the cumulative oxycodone consumed. Main secondary endpoints were pain scores (numeric rating scale NRS), operative time and hospital stay.

Results

The patients in LH/LAHV group consumed less opioid than the patients in the vaginal group during the 20 h period after surgery. The difference was significant at time point 4 and 6 h. The oxycodone consumed at time point 4 h was 19.9 (95 % CI 18.1–21.7) mg in laparoscopic group and 22.8 (20.7–25.0) mg in vaginal group (p = 0.040) and at time point 6 h was 23.5 (21.5–25.6) mg in laparoscopic group and 27.4 (24.7–30.0) mg in vaginal group (p = 0.026). Pain scores were lower after laparoscopic approach and the difference was significant at time point 60 min after surgery (p = 0.026).

Conclusion

In this study, LH was associated with reduced need of analgesics and lower acute postoperative pain scores than VH.

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References

  1. Mehra S, Bhat V, Mehra G (1999) Laparoscopic vs. abdominal vs. vaginal hysterectomy. Gynaecol Endosc 8:29–34

    Article  Google Scholar 

  2. Garry R, Fountain J, Mason S et al (2004) The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ 328:129–136

    Article  PubMed Central  PubMed  Google Scholar 

  3. Summitt RL, Stovall T, Lipscomp G, Ling F (1992) Randomized comparison of laparoscopy-assisted vaginal hysterectomy with standard vaginal hysterectomy in an outpatient setting. Obstet Gynecol 80:895–901

    PubMed  Google Scholar 

  4. Soriano D, Goldstein A, Lecuru F, Darai E (2001) Recovery from vaginal hysterectomy compared with laparoscopy-assisted vaginal hysterectomy: a prospective, randomized, multicenter study. Acta Obstet Gynecol Scand 80:337–341

    CAS  PubMed  Google Scholar 

  5. Candiani M, Izzo S, Bulfoni A, Riparini J, Ronzoni S, Marconi A (2009) Laparoscopic vs vaginal hysterectomy for benign pathology. Obstet Gynecol 200:368.e1–368.e7

    Google Scholar 

  6. Roy KK, Goyal M, Singla S, Sharma JB, Malhotra N, Kumar S (2011) A prospective randomised study of total laparoscopic hysterectomy, laparoscopically assisted vaginal hysterectomy and non-descent vaginal hysterectomy for the treatment of benign diseases of the uterus. Arch Gynecol Obstet 284:907–912

    Article  PubMed  Google Scholar 

  7. Schindlbeck C, Klauser K, Dian D, Janni W, Friese K (2008) Comparison of total laparoscopic, vaginal and abdominal hysterectomy. Arch Gynecol Obstet 277:331–337

    Article  PubMed  Google Scholar 

  8. Candiani M, Izzo S (2010) Laparoscopic versus vaginal hysterectomy for benign pathology. Curr Opin Obstet Gynecol 22:304–308

    PubMed  Google Scholar 

  9. Nieboer TE, Johnson N, Lethaby A et al (2009) Surgical approach to hysterectomy for benign gynecological disease (review). Cochrane Database Syst Rev 3:CD003677

    PubMed  Google Scholar 

  10. ACOG committee opinion 444 (2009) Choosing the route of hysterectomy. Obstet Gynecol 5:1156–1158

    Google Scholar 

  11. Wu CL, Raja SN (2011) Treatment of acute postoperative pain. Lancet 377:2215–2225

    Article  CAS  PubMed  Google Scholar 

  12. Perkins F, Kehlet H (2000) Chronic pain as an outcome of surgery: a review of predictive factors. Anesthesiology 93:1123–1133

    Article  CAS  PubMed  Google Scholar 

  13. Phillips CJ, Harper C (2011) The economics associated with persistent pain. Curr Opin Support Palliat Care 5:127–130

    Article  PubMed  Google Scholar 

  14. Gendy R, Walsh CA, Walsh SR, Karantanis E (2011) Vaginal hysterectomy versus total laparoscopic hysterectomy for benign disease: A metaanalysis of randomized controlled trials. Am J Obstet Gynecol 204:388.e1–388.e8

    Article  Google Scholar 

  15. Schnider TW, Minto CF, Gambus PL et al (1998) The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology 88:1170–1182

    Article  CAS  PubMed  Google Scholar 

  16. Minto CF, Schnider TW, Shafer SL (1997) Pharmacokinetics and pharmacodynamics of remifentanil: II. model application. Anesthesiology 86:24–33

    Article  CAS  PubMed  Google Scholar 

  17. Jokela R, Ahonen J, Tallgren M, Haanpaa M, Korttila K (2008) A randomized controlled trial of perioperative administration of pregabalin for pain after laparoscopic hysterectomy. Pain 134:106–112

    Article  CAS  PubMed  Google Scholar 

  18. Ghezzi F, Uccella S, Cromi A et al (2010) Postoperative pain after laparoscopic and vaginal hysterectomy for benign gynecologic disease: A randomized trial. Am J Obstet Gynecol 203:118.e1–118.e8

    Article  Google Scholar 

  19. Brummer THI, Jalkanen J, Fraser J et al (2009) FINHYST 2006 - national prospective 1-year survey of 5 279 hysterectomies. Hum Reprod 24:2515–2522

    Article  PubMed  Google Scholar 

  20. Johnson N, Barlow D, Lethaby A, Tavander E, Curr E, Garry R (2005) Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ 330:1478

    Article  PubMed Central  PubMed  Google Scholar 

  21. Kovac S (2014) Route of hysterectomy: an evidence-based approach. Clin Obstet Gyn 57:58–71

    Article  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest and they have full control of all primary data and agree to allow the journal to review the data if requested. No study sponsors have been involved.

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Authors and Affiliations

  1. Department of Anesthesia, Tampere University Hospital, PO Box 2000, 33521, Tampere, Finland

    Satu M. Pokkinen, Maija-Liisa Kalliomäki & Arvi Yli-Hankala

  2. Medical School, University of Tampere, Tampere, Finland

    Arvi Yli-Hankala

  3. Department of Obstetrics and Gynecology, Tampere University Hospital, PO Box 2000, 33521, Tampere, Finland

    Kari Nieminen

Authors
  1. Satu M. Pokkinen
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  2. Maija-Liisa Kalliomäki
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  3. Arvi Yli-Hankala
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  4. Kari Nieminen
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Corresponding author

Correspondence to Satu M. Pokkinen.

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Pokkinen, S.M., Kalliomäki, ML., Yli-Hankala, A. et al. Less postoperative pain after laparoscopic hysterectomy than after vaginal hysterectomy. Arch Gynecol Obstet 292, 149–154 (2015). https://doi.org/10.1007/s00404-014-3608-7

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  • DOI: https://doi.org/10.1007/s00404-014-3608-7

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