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Pain Characteristics after Total Laparoscopic Hysterectomy
Article Number: SIS913052AI211222
21st December, 2022
Author(s):
Jong Bum Choi1, Kyeongjin Kang2, Mi Kyung Song3, Suhyun Seok1, Yoon Hee Kim4, and Ji Eun Kim1
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.