Skip to main content
SpringerLink
Log in

Obstetrics and Gynecology

  • Chapter
  • First Online:
Perioperative Pain Control: Tools for Surgeons

  • 589 Accesses

Abstract

Gynecologic surgery is performed by many different approaches and for a variety of indications. One of the most common operations, hysterectomy, is performed in over 500,000 women annually in the United States. Prior methods of postoperative pain control relied heavily on the use of opioid pain medications, but modern applications of postoperative analgesia have shifted to focus on multimodal approaches in pain control. To facilitate early postoperative convalescence and reduce reliance on opioid pain medications, gynecologic surgeons must be able to apply these modern approaches to postoperative pain control. This chapter explores multimodal pharmacologic, nonpharmacologic, and intraoperative techniques for postoperative pain control with a focus on opioid-sparing modalities to help aid gynecologic surgeons in treating and preventing postoperative pain with a focus on the patient undergoing hysterectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Congress t. H.R.3244 – Victims of Trafficking and Violence Protection Act of 2000. 1999 cited; Available from: https://www.congress.gov/bill/106th-congress/house-bill/3244/text

  2. Dowdy SC, Kalogera E, Scott M. Optimizing preanesthesia care for the gynecologic patient. Obstet Gynecol. 2019;134(2):395–408.

    Article  Google Scholar 

  3. Azari L, Santoso JT, Osborne SE. Optimal pain management in total abdominal hysterectomy. Obstet Gynecol Surv. 2013;68(3):215–27.

    Article  Google Scholar 

  4. Kalogera E, Bakkum-Gamez JN, Jankowski CJ, Trabuco E, Lovely JK, Dhanorker S, et al. Enhanced recovery in gynecologic surgery. Obstet Gynecol. 2013;122(2 Pt 1):319–28.

    Article  Google Scholar 

  5. Bateman BT, Cole NM, Maeda A, Burns SM, Houle TT, Huybrechts KF, et al. Patterns of opioid prescription and use after cesarean delivery. Obstet Gynecol. 2017;130(1):29–35.

    Article  Google Scholar 

  6. Jozwiak-Bebenista M, Nowak JZ. Paracetamol: mechanism of action, applications and safety concern. Acta Pol Pharm. 2014;71(1):11–23.

    CAS  PubMed  Google Scholar 

  7. Nir RR, Nahman-Averbuch H, Moont R, Sprecher E, Yarnitsky D. Preoperative preemptive drug administration for acute postoperative pain: a systematic review and meta-analysis. Eur J Pain. 2016;20(7):1025–43.

    Article  CAS  Google Scholar 

  8. Botting R, Ayoub SS. COX-3 and the mechanism of action of paracetamol/acetaminophen. Prostaglandins Leukot Essent Fatty Acids. 2005;72(2):85–7.

    Article  CAS  Google Scholar 

  9. Prabhu M, Bortoletto P, Bateman BT. Perioperative pain management strategies among women having reproductive surgeries. Fertil Steril. 2017;108(2):200–6.

    Article  Google Scholar 

  10. Macario A, Royal MA. A literature review of randomized clinical trials of intravenous acetaminophen (paracetamol) for acute postoperative pain. Pain Pract. 2011;11(3):290.

    Article  Google Scholar 

  11. Valadan M, Banifatemi S, Yousefshahi F. Preoperative gabapentin to prevent postoperative shoulder pain after laparoscopic ovarian cystectomy: a randomized clinical trial. Anesth Pain Med. 2015;5(6):e31524.

    Article  Google Scholar 

  12. Patel R, Dickenson AH. Mechanisms of the gabapentinoids and alpha 2 delta-1 calcium channel subunit in neuropathic pain. Pharmacol Res Perspect. 2016;4(2):e00205.

    Article  Google Scholar 

  13. Jokela R, Ahonen J, Tallgren M, Haanpaa M, Korttila K. Premedication with pregabalin 75 or 150 mg with ibuprofen to control pain after day-case gynaecological laparoscopic surgery. Br J Anaesth. 2008;100(6):834–40.

    Article  CAS  Google Scholar 

  14. Kaloo P, Armstrong S, Kaloo C, Jordan V. Interventions to reduce shoulder pain following gynaecological laparoscopic procedures. Cochrane Database Syst Rev. 2019;1:CD011101.

    PubMed  Google Scholar 

  15. Matteson KA. Committee opinion no. 701 summary: choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2017;129(6):1149–50.

    Article  Google Scholar 

  16. Lee CL, Wu KY, Huang CY, Yen CF. Comparison of LigaSure tissue fusion system and a conventional bipolar device in hysterectomy via natural orifice transluminal endoscopic surgery (NOTES): a randomized controlled trial. Taiwan J Obstet Gynecol. 2019;58(1):128–32.

    Article  Google Scholar 

  17. Choi GJ, Kang H, Baek CW, Jung YH, Kim DR. Effect of intraperitoneal local anesthetic on pain characteristics after laparoscopic cholecystectomy. World J Gastroenterol. 2015;21(47):13386–95.

    Article  CAS  Google Scholar 

  18. Mazloomdoost D, Pauls RN, Hennen EN, Yeung JY, Smith BC, Kleeman SD, et al. Liposomal bupivacaine decreases pain following retropubic sling placement: a randomized placebo-controlled trial. Am J Obstet Gynecol. 2017;217(5):598 e1–e11.

    Article  Google Scholar 

  19. Barron KI, Lamvu GM, Schmidt RC, Fisk M, Blanton E, Patanwala I. Wound infiltration with extended-release versus short-acting bupivacaine before laparoscopic hysterectomy: a randomized controlled trial. J Minim Invasive Gynecol. 2017;24(2):286–92.

    Article  Google Scholar 

  20. Taş B, Donatsky AM, Gögenur I. Techniques to reduce shoulder pain after laparoscopic surgery for benign gynaecological disease: a systematic review. Gynecol Surg. 2013;10(3):169–75.

    Article  Google Scholar 

  21. Kyle EB, Maheux-Lacroix S, Boutin A, Laberge PY, Lemyre M. Low vs standard pressures in gynecologic laparoscopy: a systematic review. JSLS. 2016;20(1) https://doi.org/10.4293/JSLS.2015.00113.

  22. Herrmann A, De Wilde RL. Insufflation with humidified and heated carbon dioxide in short-term laparoscopy: a double-blinded randomized controlled trial. Biomed Res Int. 2015;2015:412618.

    Article  Google Scholar 

  23. Cohen SL, Clark NV, Ajao MO, Brown DN, Gargiulo AR, Gu X, et al. Prospective evaluation of manual Morcellation techniques: Minilaparotomy versus vaginal approach. J Minim Invasive Gynecol. 2019;26(4):702–8.

    Article  Google Scholar 

  24. Griffith KC, Clark NV, Mushinski AA, Gu X, Ajao MO, Brown DN, et al. Incisional outcomes of umbilical vs suprapubic mini-laparotomy for tissue extraction: a retrospective cohort study. J Minim Invasive Gynecol. 2018;25(6):1024–30.

    Article  Google Scholar 

  25. Griffin EPHHR. The use of topical anaesthesia of the peritoneum in poor risk surgery and in augmenting inadequate vertebral conduction anaesthesia. N Z Med J. 1951;50(Feb):275.

    Google Scholar 

  26. Boddy AP, Mehta S, Rhodes M. The effect of intraperitoneal local anesthesia in laparoscopic cholecystectomy: a systematic review and meta-analysis. Anesth Analg. 2006;103(3):682–8.

    Article  CAS  Google Scholar 

  27. Westermann LB, Crisp CC, Oakley SH, Mazloomdoost D, Kleeman SD, Benbouajili JM, et al. To pack or not to pack? A randomized trial of vaginal packing after vaginal reconstructive surgery. Female Pelvic Med Reconstr Surg. 2016;22(2):111–7.

    Article  Google Scholar 

  28. Blanton E, Lamvu G, Patanwala I, Barron KI, Witzeman K, Tu FF, et al. Non-opioid pain management in benign minimally invasive hysterectomy: a systematic review. Am J Obstet Gynecol. 2017;216(6):557–67.

    Article  Google Scholar 

  29. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of postoperative pain: a clinical practice guideline from the American pain society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative council. J Pain. 2016;17(2):131–57.

    Article  Google Scholar 

  30. Thompson JC, Komesu YM, Qeadan F, Jeppson PC, Cichowski SB, Rogers RG, et al. Trends in patient procurement of postoperative opioids and route of hysterectomy in the United States from 2004 through 2014. Am J Obstet Gynecol. 2018;219(5):484 e1–e11.

    Article  Google Scholar 

  31. O’Hara DA, Fragen RJ, Kinzer M, Pemberton D. Ketorolac tromethamine as compared with morphine sulfate for treatment of postoperative pain. Clin Pharmacol Ther. 1987;41(5):556–61.

    Article  Google Scholar 

  32. Power I, Noble DW, Douglas E, Spence AA. Comparison of I.m. ketorolac trometamol and morphine sulphate for pain relief after cholecystectomy. Br J Anaesth. 1990;65(4):448–55.

    Article  CAS  Google Scholar 

  33. Pather S, Loadsman JA, Gopalan PD, Rao A, Philp S, Carter J. The role of transversus abdominis plane blocks in women undergoing total laparoscopic hysterectomy: a retrospective review. Aust N Z J Obstet Gynaecol. 2011;51(6):544–7.

    Article  Google Scholar 

  34. Ghisi D, Fanelli A, Vianello F, Gardini M, Mensi G, La Colla L, et al. Transversus abdominis plane block for postoperative analgesia in patients undergoing total laparoscopic hysterectomy: a randomized, controlled, observer-blinded trial. Anesth Analg. 2016;123(2):488–92.

    Article  CAS  Google Scholar 

  35. Gasanova I, Alexander J, Ogunnaike B, Hamid C, Rogers D, Minhajuddin A, et al. Transversus abdominis plane block versus surgical site infiltration for pain management after open total abdominal hysterectomy. Anesth Analg. 2015;121(5):1383–8.

    Article  Google Scholar 

  36. Courtney-Brooks M, Tanner Kurtz KC, Pelkofski EB, Nakayama J, Duska LR. Continuous epidural infusion anesthesia and analgesia in gynecologic oncology patients: less pain, more gain? Gynecol Oncol. 2015;136(1):77–81.

    Article  Google Scholar 

  37. Sun Y, Gan TJ, Dubose JW, Habib AS. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. Br J Anaesth. 2008;101(2):151–60.

    Article  CAS  Google Scholar 

  38. Elvir-Lazo OL, White PF. The role of multimodal analgesia in pain management after ambulatory surgery. Curr Opin Anaesthesiol. 2010;23(6):697–703.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Denver Health and Hospital Authority, Denver, CO, USA

    Tyler Muffly

  2. Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA

    Tyler Muffly & Javier Gonzalez

Authors
  1. Tyler Muffly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Javier Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tyler Muffly .

Editor information

Editors and Affiliations

  1. Bergen Medical Associates, Emerson, NJ, USA

    Peter F. Svider

  2. Anesthesiology, Pain Medicine, Columbia University Irving Medical Center, New York, NY, USA

    Anna A. Pashkova

  3. Otolaryngology – Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Andrew P. Johnson

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Muffly, T., Gonzalez, J. (2021). Obstetrics and Gynecology. In: Svider, P.F., Pashkova, A.A., Johnson, A.P. (eds) Perioperative Pain Control: Tools for Surgeons. Springer, Cham. https://doi.org/10.1007/978-3-030-56081-2_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-56081-2_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-56080-5

  • Online ISBN: 978-3-030-56081-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation