Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations

PROSPECT Working Group

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVES: Laparoscopic hysterectomy is increasingly performed because it is associated with less postoperative pain and earlier recovery as compared with open abdominal hysterectomy. The aim of this systematic review was to evaluate the available literature regarding the management of pain after laparoscopic hysterectomy. STRATEGY AND SELECTION CRITERIA: Randomized controlled trials evaluating postoperative pain after laparoscopic hysterectomy published between January 1996 and May 2018 were retrieved, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, from the EMBASE and MEDLINE databases and the Cochrane Register of Controlled Trials. Efficacy and adverse effects of analgesic techniques were assessed. RESULTS: Of the 281 studies initially identified, 56 were included. Of these, 31 assessed analgesic or anesthetic interventions and 25 assessed surgical interventions. Acetaminophen, non-steroidal anti-inflammatory drugs, and dexamethasone reduced opioid consumption. Limited evidence hindered recommendations on alpha-2-agonists. Inconsistent evidence was found in the studies investigating pregabalin and transversus abdominis plane block, and no evidence was found for intraperitoneal local anesthetics, port site infiltration, or single-port laparoscopy. Measures to lower peritoneal insufflation pressure or humidify or heat insufflated gas seem to reduce the incidence of shoulder pain, but not abdominal pain. CONCLUSIONS: The baseline analgesic regimen for laparoscopic hysterectomy should include acetaminophen, a non-steroidal anti-inflammatory drug, dexamethasone, and opioids as rescue analgesics.

Original languageEnglish (US)
Pages (from-to)425-436
Number of pages12
JournalRegional anesthesia and pain medicine
Volume44
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Pain Management
Hysterectomy
Analgesics
Acetaminophen
Postoperative Pain
Dexamethasone
Opioid Analgesics
Anti-Inflammatory Agents
Abdominal Muscles
Insufflation
Shoulder Pain
Local Anesthetics
MEDLINE
Pharmaceutical Preparations
Laparoscopy
Abdominal Pain
Patient Selection
Anesthetics
Meta-Analysis
Randomized Controlled Trials

Keywords

  • analgesia
  • evidence-based medicine
  • laparoscopic hysterectomy
  • pain
  • systematic review

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Pain management after laparoscopic hysterectomy : systematic review of literature and PROSPECT recommendations. / PROSPECT Working Group.

In: Regional anesthesia and pain medicine, Vol. 44, No. 4, 01.04.2019, p. 425-436.

Research output: Contribution to journalArticle

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