Pain Characteristics after Total Laparoscopic Hysterectomy

Jong Bum Choi, Kyeongjin Kang, Mi Kyung Song, Suhyun Seok, Yoon Hee Kim, Ji Eun Kim, Jong Bum Choi, Kyeongjin Kang, Mi Kyung Song, Suhyun Seok, Yoon Hee Kim, Ji Eun Kim

Abstract

Background. Total laparoscopic hysterectomy (TLH) causes various types of postoperative pain, and the pain pattern has not been evaluated in detail to date. This prospective observational study investigated the types of postoperative pain, intensity in the course of time, and pain characteristics during the first postoperative 72 hr after TLH. Methods. Sixty four female patients undergoing TLH were enrolled, which finally 50 patients were included for the data analyses. The locations of pain included overall pain, abdominal visceral and incisional pains, shoulder pain, and perineal pain. Assessments were made at rest and in motion, and pain level was scored with the use of the 100 mm visual analog scale. The pain was assessed at baseline, and at postoperative 30 min, 1 hr, 3 hr, 6 hr, 24 hr, 48 hr, and 72 hr. Results. Overall, visceral, and incisional pains were most intense on the day of operation and then decreased following surgery. In contrast, shoulder pain gradually increased, peaking at postoperative 24 hr. Shoulder pain developed in 90% of all patients (44/50). It was not more aggravated in motion than at rest, in comparison with other pains, and right shoulder pain was more severe than left shoulder pain (p=0.006). In addition, the preoperative exercise habit of patients increased the threshold of shoulder pain. Most patients (46/50) had perineal pain, which was more severe than abdominal pain in approximately 30% of patients (17/50). Conclusion. Pain after TLH showed considerably different duration, severity, and characteristics, compared with other laparoscopic procedures. Shoulder pain was most intense at postoperative 24 hr, and the intensity was associated with the prior exercise habit of patients and the high level of analgesic request.

Keywords: Exercise habit; Laparoscopic hysterectomy; Postoperative pain; Shoulder pain.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Flow diagram
Figure 2
Figure 2
Pains after total laparoscopic hysterectomy. The pain score was expressed using a 100 mm visual analog scale (VAS).
Figure 3
Figure 3
Effects of exercise habit on overall pain (A), visceral pain (B), and shoulder pain (C). * Indicates a statistically significant difference compared with the control group (p

Figure 3

Effects of exercise habit on…

Figure 3

Effects of exercise habit on overall pain (A), visceral pain (B), and shoulder…

Figure 3
Effects of exercise habit on overall pain (A), visceral pain (B), and shoulder pain (C). * Indicates a statistically significant difference compared with the control group (p

Figure 4

Bilateral shoulder pains. * Indicates…

Figure 4

Bilateral shoulder pains. * Indicates a statistically significant difference compared with the right…

Figure 4
Bilateral shoulder pains. * Indicates a statistically significant difference compared with the right shoulder (p

Figure 5

The percentage of patients using…

Figure 5

The percentage of patients using additional analgesics. X-axis is defined by the period…

Figure 5
The percentage of patients using additional analgesics. X-axis is defined by the period of time. For example, postoperative 0.5 hr in the graph means the entire period of PACU arrival and postoperative 30 min.
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References
    1. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev; 2009. doi:10.1002/14651858.CD003677.pub4.(3):CD003677. - PubMed
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Figure 3
Figure 3
Effects of exercise habit on overall pain (A), visceral pain (B), and shoulder pain (C). * Indicates a statistically significant difference compared with the control group (p

Figure 4

Bilateral shoulder pains. * Indicates…

Figure 4

Bilateral shoulder pains. * Indicates a statistically significant difference compared with the right…

Figure 4
Bilateral shoulder pains. * Indicates a statistically significant difference compared with the right shoulder (p

Figure 5

The percentage of patients using…

Figure 5

The percentage of patients using additional analgesics. X-axis is defined by the period…

Figure 5
The percentage of patients using additional analgesics. X-axis is defined by the period of time. For example, postoperative 0.5 hr in the graph means the entire period of PACU arrival and postoperative 30 min.
Similar articles
Cited by
References
    1. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev; 2009. doi:10.1002/14651858.CD003677.pub4.(3):CD003677. - PubMed
    1. Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118(4):934–44. - PubMed
    1. Ekstein P, Szold A, Sagie B, Werbin N, Klausner JM, Weinbroum AA. Laparoscopic surgery may be associated with severe pain and high analgesia requirements in the immediate postoperative period. Ann Surg. 2006;243(1):41–6. - PMC - PubMed
    1. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2–15. - PMC - PubMed
    1. Bisgaard T, Rosenberg J, Kehlet H. From acute to chronic pain after laparoscopic cholecystectomy: a prospective follow-up analysis. Scand J Gastroenterol. 2005;40(11):1358–64. - PubMed
Show all 42 references
MeSH terms
Related information
[x]
Cite
Copy Download .nbib .nbib
Format: AMA APA MLA NLM
Figure 4
Figure 4
Bilateral shoulder pains. * Indicates a statistically significant difference compared with the right shoulder (p

Figure 5

The percentage of patients using…

Figure 5

The percentage of patients using additional analgesics. X-axis is defined by the period…

Figure 5
The percentage of patients using additional analgesics. X-axis is defined by the period of time. For example, postoperative 0.5 hr in the graph means the entire period of PACU arrival and postoperative 30 min.
Figure 5
Figure 5
The percentage of patients using additional analgesics. X-axis is defined by the period of time. For example, postoperative 0.5 hr in the graph means the entire period of PACU arrival and postoperative 30 min.

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