Contemporary opioid-sparing approaches after hysterectomy

Abstract

Hysterectomy is one of the most common interventions in the field of operative gynecology that can be done in various surgical ways. Regardless of the operative technique, the uterine ablation causes moderate to severe postoperative pain. The pain has both visceral and somatic origins. High-quality analgesia after hysterectomy is an important precondition for obtaining rapid convalescence and dehospitalization in the conditions of a psychoemotional comfort. Good analgesia decreases the risk of developing chronic neuropathic pain syndromes. Morphine mimetics are the most commonly used analgesics for obtaining a pain relief after hysterectomy. Their powerful analgesic effect, unfortunately, is related to a number of side effects such as nausea, vomiting, alteration of consciousness, and others. This evokes the research of new analgesic strategies in postoperative pain relief that are able to reduce the use of opioids for acute pain relief. The simultaneous use of different analgesic medicaments and techniques, with various modes of action and site of application, constitutes the modern approach in the aim of reducing opioid consumption. This article provides a brief overview of the modern possibilities for the implementation of multimodal analgesia in the postoperative period after hysterectomy. The main groups of different analgesics, their potential, side effects and recommended dosages are discussed. We have made a brief presentation of the regional anesthesia techniques and local anesthetic agents that have a potential to provide pain relief after hysterectomy.