title: Pain Characteristics after Total Laparoscopic Hysterectomy.
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.
authors: 1. Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
authors: Jong Bum
authors: JB
authors: Choi
authors: 2. Department of Anatomy and Cell Biology, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea.
authors: Kyeongjin
authors: K
authors: Kang
authors: 3. Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Mi Kyung
authors: MK
authors: Song
authors: 1. Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
authors: Suhyun
authors: S
authors: Seok
authors: 4. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Yoon Hee
authors: YH
authors: Kim
authors: 1. Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
authors: Ji Eun
authors: JE
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000503:physiopathology*; D020069:Shoulder Pain
chemical_list: D000700:Analgesics
keywords: Exercise habit; Laparoscopic hysterectomy; Postoperative pain; Shoulder pain