title: Components of pain assessment after laparoscopic donor nephrectomy.
abstract: BACKGROUND
  Pain after laparoscopic surgery can be divided into three components: incisional or superficial wound pain, deep intra-abdominal pain and referred shoulder pain. Better understanding and adequate assessment of post-operative pain may be an important clue to the optimisation of recovery after laparoscopic surgery. Therefore, we performed a components of pain assessment after laparoscopic donor nephrectomy.
  
  
  METHODS
  Twenty patients who underwent a laparoscopic donor nephrectomy were included in this prospective study. Pain was subdivided into three components: superficial wound pain, deep intra-abdominal pain and referred shoulder pain, and for each component a numeric rating scale (from 0 to 10) was obtained at 1, 24 and 48 h after surgery.
  
  
  RESULTS
  Repeated measurements analysis of variance showed that during the first 48 h after surgery, the superficial wound and deep intra-abdominal pain components were significantly higher as compared with the referred shoulder pain component. Although the deep intra-abdominal pain component was slightly higher as compared with superficial wound pain, this difference was not significant (P = 0.097). Further assessment of superficial wound pain showed that the Pfannenstiel incision was the most significant determinant of this component of pain (P = 0.004), whereas deep intra-abdominal pain was significantly higher at the ipsilateral side of the abdomen (P = 0.015).
  
  
  CONCLUSIONS
  The components of pain assessment revealed that pain related to the Pfannenstiel incision and the deep intra-abdominal pain component are the most important determinants of pain after laparoscopic donor nephrectomy. Further improvement of the management of post-operative pain should focus on these components of pain.
authors.affiliation: Department of Surgery, Division of Vascular and Transplant Surgery, Radboud University Nijmegen Medical Center, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Ergün
authors.forename: A W
authors.initials: AW
authors.lastname: Berkers
authors.forename: M F
authors.initials: MF
authors.lastname: van der Jagt
authors.forename: J F
authors.initials: JF
authors.lastname: Langenhuijsen
authors.forename: D
authors.initials: D
authors.lastname: van Özdemir-Brunschot
authors.forename: J A
authors.initials: JA
authors.lastname: van der Vliet
authors.forename: F C
authors.initials: FC
authors.lastname: D'Ancona
authors.forename: M C
authors.initials: MC
authors.lastname: Warlé
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000328:Adult; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000188:drug therapy; D020250:Postoperative Nausea and Vomiting / Q000175:diagnosis / Q000628:therapy; D011446:Prospective Studies; D020069:Shoulder Pain / Q000175:diagnosis / Q000209:etiology