Improved recovery using multimodal perioperative analgesia in minimally invasive myomectomy: a randomised study

To evaluate postoperative pain using a multimodal analgesic protocol in women with uterine fibroids managed with minimally invasive myomectomy.

A prospective randomised trial was designed to evaluate the postoperative pain of women treated with minimally invasive myomectomy, using a multimodal analgesic protocol (consisting of perioperative pharmaceutical agents of local and systemic action adjuvant to the classic anaesthesia protocol). Ninety-five premenopausal women were assessed for minimally invasive myomectomy (laparoscopic myomectomy and laparoscopically assisted myomectomy). Ninety-two women were included in the final analysis and were randomly allocated in two groups using sealed envelopes: group I (n=47) consisted of women who received the multimodal analgesic protocol and was compared with group II (n=45) who did not receive the protocol. The main outcome measure was the postoperative pain score at 2 and 8 h after surgery, according to the Visual Analog Scale (VAS). Additionally, time for bowel peristalsis return, duration of hospitalisation and full recuperation to normal activity were also measured.

Significantly lower VAS scores for postoperative pain, earlier return of bowel peristalsis and fewer hours of hospitalisation were observed in the group in which multimodal analgesia was used. The days for the full recuperation to normal activity were similar between the two groups.

In the setting of minimally invasive myomectomy, the use of a multimodal analgesic protocol improved postoperative recovery, resulting in earlier hospital discharge.