Effects of closed suction drainage in reducing pain after laparoscopic-assisted vaginal hysterectomy.
OBJECTIVE
To estimate whether closed suction drainage of the pelvis after laparoscopic-assisted vaginal hysterectomy (LAVH) reduces the frequency and intensity of shoulder-tip, abdominal, and back pain.


METHODS
Prospective, randomized study (Canadian Task Force classification 1).


METHODS
Teaching medical center.


METHODS
One hundred sixty-four women.


METHODS
LAVH.


RESULTS
For group 1 (80 women), closed suction (Jackson-Pratt) drains were inserted into the peritoneal cavity and cul-de-sac, whereas for group 2 (84), no drains were placed. Shoulder-tip, abdominal, and back pain were evaluated by visual analog scores (VAS) 3, 24, and 48 hours after surgery. The frequency of shoulder-tip pain was significantly lower in group 1 at 24 hours (23% vs 40%, p = 0.013) and 48 hours (9% vs 21%, p = 0.024; VAS scores at 24 hrs 2.2 +/- 1.1 vs 3.8 +/- 1.3, p = 0.010; VAS scores at 48 hours 1.5 +/- 1.0 vs 2.5 +/- 1.2, p = 0.018). At 48 hours fewer women in group 1 experienced abdominal pain (31% vs 50%, p = 0.039; VAS scores 2.0 +/- 1.1 vs 4.0 +/- 1.3, p = 0.007). No statistically significant differences in frequency and VAS scores for back pain were found at any time. The quantity of oral analgesics was greater for group 2 than for group 1 (12.4 +/- 1.6 vs 9.0 +/- 1.4, p <0.001). Economic evaluation of analgesic requirements and material costs for the two groups showed that simple analgesics were more cost-effective than closed suction drainage in the treatment of pain.


CONCLUSIONS
Closed suction drains may reduce the frequency and intensity of shoulder-tip and abdominal pain and postoperative analgesia requirements after LAVH, but simple oral analgesics are more cost effective.
Shen
Chung-Chang
CC
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan.
Wu
Ming-Ping
MP
Lu
Cheng-Hsien
CH
Kung
Fu-Tsai
FT
Huang
Fu-Jen
FJ
Huang
Eng-Yen
EY
Chang
Hsueh-Wen
HW
Yang
Lin-Cheng
LC
Hsu
Te-Yao
TY
Chang
Shiuh-Young
SY
D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy; D000328:Adult; D001416:Back Pain / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005831:Genital Diseases, Female / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects* / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000628:therapy*; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D012720:Severity of Illness Index; D013396:Suction / Q000379:methods; D016896:Treatment Outcome