Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations
Philipp Lirk, Juliette Thiry, Marie-Pierre Bonnet, Girish P Joshi, Francis Bonnet, PROSPECT Working Group, H Beloeil, A Hill, H Kehlet, P Lavand'homme, E Pogatzki-Zahn, N Rawal, J Raeder, S Schug, M van de Velde, Philipp Lirk, Juliette Thiry, Marie-Pierre Bonnet, Girish P Joshi, Francis Bonnet, PROSPECT Working Group, H Beloeil, A Hill, H Kehlet, P Lavand'homme, E Pogatzki-Zahn, N Rawal, J Raeder, S Schug, M van de Velde
Abstract
Background and objectives: Laparoscopic 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 criteria: Randomized 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.
Results: Of 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.
Conclusions: The baseline analgesic regimen for laparoscopic hysterectomy should include acetaminophen, a non-steroidal anti-inflammatory drug, dexamethasone, and opioids as rescue analgesics.
Keywords: analgesia; evidence-based medicine; laparoscopic hysterectomy; pain; systematic review.
Conflict of interest statement
Competing interests: GPJ has received honoraria from Baxter, Mallinckrodt, Pacira, and Merck Pharmaceuticals. FB has received honoraria from Pfizer, The Medicines Company, Abbott France, and Nordic Pharma France. Henrik Kehlet has received honoraria from Pfizer and Grunenthal. The Anesthesiology Unit of the University of Western Australia, but not Stephan Schug privately, has received research and travel funding and speaking and consulting honoraria from bioCSL, Eli Lilly, Indivior, iX Biopharma, and Pfizer within the last 2 years. Narinder Rawal has received honoraria from Baxter and Sintetica.
© American Society of Regional Anesthesia & Pain Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Source: PubMed