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Postoperative pain after laparoscopic and vaginal hysterectomy for benign gynecologic disease: a randomized trial

      Objective

      To compare postoperative pain after laparoscopic and vaginal hysterectomy for benign disease.

      Study Design

      A prospective randomized trial was designed to compare laparoscopic hysterectomy and vaginal hysterectomy in patients with uterine volume ≤14 weeks of gestation. Postoperative pain was measured using the visual analog scale (VAS) at 1, 3, 8, and 24 hours postoperatively. Intra- and postoperative outcomes were carefully recorded, including the need for postoperative rescue doses of analgesia.

      Results

      A total of 82 patients were enrolled. Patients who underwent vaginal hysterectomy complained of higher postoperative pain at each VAS evaluation (VAS-1 hour, P < .0001; VAS-3 hour, P < .0001; VAS-8 hour, P < .0001; VAS-24 hour, P = .0003) with a higher need for rescue analgesia (P < .0001) and a longer hospitalization (P = .001). The other perioperative characteristics were comparable between the 2 groups.

      Conclusion

      Laparoscopic hysterectomy provides an advantage over vaginal hysterectomy in terms of postoperative pain, need for rescue analgesia and hospital stay, with similar perioperative outcomes.

      Key words

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      References

        • Rosenquist R.W.
        • Rosenberg J.
        Postoperative pain guidelines.
        Reg Anesth Pain Med. 2003; 28: 279-288
        • Bonica J.J.
        The need of a taxonomy.
        Pain. 1979; 6: 247-248
        • NHMRC, Commonwealth of Australia, National Health and Medical Research Council
        Acute Pain. 1999
        • Agency for Health Care Policy and Research (AHCPR)
        Pain control after surgery—a patient guide. AHCPR, Public Health Services, U.S. Department of Health and Human Services, Rockville, MD1992 (report no. 92-0021)
        • Nieboer T.E.
        • Johnson N.
        • Lethaby A.
        • et al.
        Surgical approach to hysterectomy for benign gynaecological disease (review).
        Cochrane Database Syst Rev. 2009; 3 (CD003677)
        • Candiani M.
        • Izzo S.
        • Bulfoni A.
        • Riparini J.
        • Ronzoni S.
        • Marconi A.
        Laparoscopic vs vaginal hysterectomy for benign pathology.
        Am J Obstet Gynecol. 2009; 200: 368.e1-368.e7
        • Summitt R.L.
        • Stovall T.G.
        • Lipscomb G.H.
        • Ling F.W.
        Randomized comparison of laparoscopic assisted vaginal hysterectomy with standard vaginal hysterectomy in an outpatient setting.
        Obstet Gynecol. 1992; 80: 895-901
        • Garry R.
        • Fountain J.
        • Mason S.
        • et al.
        The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy.
        BMJ. 2004; 328: 129-136
        • Jugnet N.
        • Cosson M.
        • Wattiez A.
        • et al.
        Comparing vaginal and celioscopic total or subtotal hysterectomies: prospective multicenter study including 82 patients.
        Gynecol Endosc. 2001; 10: 315-321
        • Ribiero S.C.
        • Ribiero R.M.
        • Santos S.C.
        • Pinotti J.A.
        A randomised study of total abdominal, vaginal and laparoscopic hysterectomy.
        Int J Gynecol Obstet. 2003; 83: 37-43
        • Soriano D.
        • Goldstein A.
        • Lecuru F.
        • Darai E.
        Recovery from vaginal hysterectomy compared with laparoscopically assisted hysterectomy: a prospective, randomised, multicenter study.
        Acta Obstet Gynecol Scand. 2001; 80: 337-341
        • Abrams P.
        • Cardozo L.
        • Fall M.
        • et al.
        The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of International Continence Society.
        Neurourol Urodyn. 2002; 21: 167-178
        • Ghezzi F.
        • Cromi A.
        • Bergamini V.
        • et al.
        Laparoscopic-assisted vaginal hysterectomy versus total laparoscopic hysterectomy for the management of endometrial cancer: a randomized clinical trial.
        J Minim Invasive Gynecol. 2006; 13: 114-120
        • Ghezzi F.
        • Cromi A.
        • Bergamini V.
        • et al.
        Laparoscopic management of endometrial cancer in nonobese and obese women: a consecutive series.
        J Minim Invasive Gynecol. 2006; 13: 269-275
        • Ghezzi F.
        • Cromi A.
        • Uccella S.
        • et al.
        Immediate Foley removal after laparoscopic and vaginal hysterectomy: determinants of post-operative urinary retention.
        J Min Inv Gynecol. 2007; 14: 706-711
        • Bonica J.J.
        The relation of injury to pain.
        Pain. 1979; 7: 203-207
        • Silva-Filho A.L.
        • Moura Rodrigues A.
        • de Castro Monteiro M.V.
        • et al.
        Randomized study of bipolar vessel sealing versus conventional suture ligature for vaginal hysterectomy.
        Eur J Obstet Gynecol Reprod Biol. 2009; 146: 200-203
        • Hefni M.A.
        • Bhaumik J.
        • El-Toukly T.
        • et al.
        Safety and efficacy of using the LigaSure vessel sealing system for securing the pedicles in vaginal hysterectomy: randomised controlled trial.
        BJOG. 2005; 112: 329-333
        • Ghezzi F.
        • Cromi A.
        • Siesto G.
        • et al.
        Needlescopic hysterectomy: incorporation of 3-mm instruments in total laparoscopic hysterectomy.
        Surg Endosc. 2008; 22: 2153-2157
        • Ghezzi F.
        • Cromi A.
        • Colombo G.
        • et al.
        Minimizing ancillary ports size in gynecologic laparoscopy: a randomized trial.
        J Minim Invasive Gynecol. 2005; 12: 480-485
        • Sculpher M.
        • Manca A.
        • Abbott J.
        • Fountain J.
        • Mason S.
        • Garry R.
        Cost effectiveness analysis of laparoscopic hysterectomy compared with standard hysterectomy: results from a randomised trial.
        BMJ. 2004; 328: 134
        • Liu S.S.
        • Wu C.L.
        The effect of analgesic technique on postoperative patient-reported outcomes including analgesia: a systematic review.
        Anesth Analg. 2007; 105: 789-808
        • Richardson R.E.
        • Bournas N.
        • Magos A.L.
        Is laparoscopic hysterectomy a waste of time?.
        Lancet. 1995; 345: 36-41