title: Preemptive analgesia for postoperative hysterectomy pain control: systematic review and clinical practice guidelines.
abstract: The objective of the study was to investigate the effectiveness of preemptive analgesia at pain control in women undergoing total abdominal hysterectomy.
  
  
  
  Eligible studies, published through May 31, 2016, were retrieved through Medline, Cochrane Central Register for Controlled Trials, and Cochrane Database of Systematic Reviews.
  
  
  
  We included randomized controlled trials with the primary outcome of pain control in women receiving a preemptive medication prior to total abdominal hysterectomy. Comparators were placebo, different doses of the same medication as intervention, or other nonnarcotic or narcotic medication.
  
  
  
  Study data were extracted by one reviewer and confirmed by a second reviewer. For each outcome we graded the quality of the evidence. Studies were classified by the type of medication used and by outcome type.
  
  
  
  Eighty-four trials met eligibility, with 69 included. Among nonnarcotic medications, paracetamol, gabapentin, and rofecoxib combined with gabapentin resulted in improvements in pain assessment compared with placebo and other nonnarcotic medications. Patient satisfaction was higher in patients who were given gabapentin combined with paracetamol compared with gabapentin alone. Use of preemptive paracetamol, gabapentin, bupivacaine, and phenothiazine resulted in less narcotic usage than placebo. All narcotics (ketamine, morphine, fentanyl) resulted in improved pain control compared with placebo. Narcotics had a greater reduction in pain assessment scores compared with nonnarcotics, and their use resulted in lower total narcotic usage.
  
  
  
  Preemptive nonnarcotic and narcotic medications prior to abdominal hysterectomy decrease total narcotic requirements and improve patient postoperative pain assessment and satisfaction scores.
authors.affiliation: Division of Urogynecology, Hartford Hospital University of the Connecticut School of Medicine, Hartford, CT. Electronic address: acsteinberg06@yahoo.com.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Steinberg
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Megan O
authors.initials: MO
authors.lastname: Schimpf
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern at Seton Healthcare Family, Austin, TX.
authors.forename: Amanda B
authors.initials: AB
authors.lastname: White
authors.affiliation: Division of Gynecology-Oncology, Department of Obstetrics and Gynecology, Alpert Medical School, Brown University, Providence, RI.
authors.forename: Cara
authors.initials: C
authors.lastname: Mathews
authors.affiliation: Division of Urogynecology and Pelvic Reconstruction, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: David R
authors.initials: DR
authors.lastname: Ellington
authors.affiliation: Division of Urogynecology, University of New Mexico, Albuquerque, NM.
authors.forename: Peter
authors.initials: P
authors.lastname: Jeppson
authors.affiliation: Division of Urogynecology, Tri Health, Cincinnati, OH.
authors.forename: Catrina
authors.initials: C
authors.lastname: Crisp
authors.affiliation: Department of Urogynecology, ProHealth Care, Women's Center, Medical College of Wisconsin, Waukesha, WI.
authors.forename: Sarit O
authors.initials: SO
authors.lastname: Aschkenazi
authors.affiliation: Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Mamta M
authors.initials: MM
authors.lastname: Mamik
authors.affiliation: Center for Evidence-Based Medicine, Brown University School of Public Health, Providence, RI.
authors.forename: Ethan M
authors.initials: EM
authors.lastname: Balk
authors.affiliation: Institute for Female Pelvic Medicine and Reconstructive Surgery, North Wales, PA.
authors.forename: Miles
authors.initials: M
authors.lastname: Murphy
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D011292:Premedication
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid
keywords: postoperative pain; preemptive analgesia; total abdominal hysterectomy