Pain degree and analgesia method after common gynecological surgeries

Abstract

Objective To analyze the status of postoperative pain, postoperative analgesia methods and adverse reactions of patients after common gynecological surgeries, in order to provide the basis for the enhanced recovery after gynecological surgery (ERAGS). Methods A part of patients treated in the First Affiliated Hospital of Zhengzhou University from May 2018 to August 2018 were enrolled in the study, including 560 cases of cervical conization, 624 patients who underwent hysteroscopy for hysteropolyps, submucosal hysteromyoma or uterine mediastinum, 432 patients who underwent laparoscopic hysterectomy for benign uterine diseases, 628 patients who underwent laparoscopic adnexal cystectomy/adnexal resection for benign adnexal diseases and 200 patients underwent laparoscopic radical surgery for gynecological malignancies. The pain scores, incidence of adverse reactions and analgesic measures, such as analgesic pumps and other analgesics (tramadol hydrochloride injection/flurbiprofen axetil injection) were analyzed and compared among patients after different types of gynecological surgeries. Visual analogue scale (VAS), numerical rating scale (NRS) or Wong-Baker facial expression scale were used to assess the degree of pain. Results A total of 214 cases (38.2%) used analgesic pump and 346 cases (61.8%) did not use analgesic pump after cervical conization; 364 cases (58.3%) used analgesic pump and 260 cases (41.7%) did not use analgesic pump after hysteroscopic surgery; 304 cases (70.4%) used analgesic pump and 128 cases (29.6%) did not use analgesic pump after hysterectomy; 392 cases (62.4%) used analgesic pump and 236 cases (37.6%) did not use analgesic pump after laparoscopic adnexal cystectomy/adnexal resection; 172 cases (86.0%) used analgesic pump and 28 cases (14.0%) did not use analgesic pump after laparoscopic radical resection of malignant tumors. There was no significant difference in pain scores between the patients with analgesic pump and patients without analgesic pump (P>0.05), but the incidence of adverse reactions of patients with analgesic pump was higher than that of patients without analgesic pump (P<0.05). The frequency of using other analgesic drugs of patients who did not use analgesic pump after hysterectomy, laparoscopic adnexal cyst removal/adnexal resection and laparoscopic radical resection of malignant tumors was higher. Conclusions The degree of pain after cervical conization is mild, so no analgesic measures are required by patients. The degree of postoperative pain in patients with excision of accessory cyst/adnexectomy is moderate. Consequently, analgesic drugs can be used which is superior to analgesic pump in reducing the occurrence of adverse reactions. The degree of postoperative pain in patients with radical operation for gynecological malignant tumor is moderate to severe, so analgesic pump is necessary to alleviate pain, but the prevention against adverse reactions should be focused. Key words: Gynecologic surgical producedures; Pain; Postoperative analgesia; Degree of pain; Enhanced recovery after surgery