Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations

Abstract

Background and objectivesLaparoscopic hysterectomy is increasingly performed because it is associated with less postoperative pain and earlier recovery as compared with open abdominal hysterectomy. The aim of this systematic review was to evaluate the available literature regarding the management of pain after laparoscopic hysterectomy.Strategy and selection criteriaRandomized controlled trials evaluating postoperative pain after laparoscopic hysterectomy published between January 1996 and May 2018 were retrieved, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, from the EMBASE and MEDLINE databases and the Cochrane Register of Controlled Trials. Efficacy and adverse effects of analgesic techniques were assessed.ResultsOf the 281 studies initially identified, 56 were included. Of these, 31 assessed analgesic or anesthetic interventions and 25 assessed surgical interventions. Acetaminophen, non-steroidal anti-inflammatory drugs, and dexamethasone reduced opioid consumption. Limited evidence hindered recommendations on alpha-2-agonists. Inconsistent evidence was found in the studies investigating pregabalin and transversus abdominis plane block, and no evidence was found for intraperitoneal local anesthetics, port site infiltration, or single-port laparoscopy. Measures to lower peritoneal insufflation pressure or humidify or heat insufflated gas seem to reduce the incidence of shoulder pain, but not abdominal pain.ConclusionsThe baseline analgesic regimen for laparoscopic hysterectomy should include acetaminophen, a non-steroidal anti-inflammatory drug, dexamethasone, and opioids as rescue analgesics.

Therapeutic Approaches for Peripheral and Central Neuropathic Pain

“…Underlying the relevance of this condition, it is estimated that 1 out of 9 women undergoes hysterectomy in the USA [27]. Proper acute pain management during/after hysterectomy may influence the development of this postsurgical chronic pain [28].…”

Pregabalin does not decrease acute pain or postoperative nausea and vomiting after hysterectomy: a meta-analysis

“…Hysterectomy causes significant postoperative pain, characterized by a combination of somatic and predominantly visceral pain. 1 Poorly managed acute postoperative pain may increase pain-related complications, delay out-of-bed activity, and affect quality of life. [2][3][4] Enhanced recovery after surgery protocols have recently undergone rapid developments and have been widely applied in orthopedic, general, and cardiothoracic surgery.…”

<p>Interaction of Analgesic Effects of Dezocine and Sufentanil for Relief of Postoperative Pain: A Pilot Study</p>

“…Further studies should assess the related adverse reactions of the combination of the two drugs and their place in the management of acute postoperative pain when different intraoperative pain management plan is used, including opioid sparing techniques (eg, multimodal pain management approach, combined spinal general anesthesia and/or quadratus lumborum block). [33][34][35] In conclusion, when simultaneously administered intravenously, combined dezocine and sufentanil produce an additive effect for relieving the acute nociception after gynecological laparoscopic surgery. Dezocine could to some extent enhance the analgesic effects of sufentanil and/or to reduce the requirement for sufentanil for acute pain management in the postoperative period.…”