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.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan.
Chung-Chang
CC
Shen
Ming-Ping
MP
Wu
Cheng-Hsien
CH
Lu
Fu-Tsai
FT
Kung
Fu-Jen
FJ
Huang
Eng-Yen
EY
Huang
Hsueh-Wen
HW
Chang
Lin-Cheng
LC
Yang
Te-Yao
TY
Hsu
Shiuh-Young
SY
Chang
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