[Effect of early multimodal rehabilitation on postoperative recovery after abdominal hysterectomy]

Purpose of the study was to evaluate the impact of the use of enhanced recovery after surgery for the postoperative period, and the inflammatory response after hysterectomy.

Methods Prospectively, 50 patients ASA 1-2 aged 42-72 years were randomized into two groups: the ERAS group (n = 25) and the control group (CG) with traditional perioperative management (n = 25). combined spinal and epidural anesthesia technique was used in all patients. Patient-controlled epidural analgesia in the ERAS group and multimodal analgesia with combination of paracetamol, tramadol and ketoprofen in the control group were used postoperatively. We measured plasma concentrations of interleukin-6 (IL-6), interleuki-nIL-1beta (IL-1beta) and C-reactive protein (CRP) preoperatively and at 24 hours and 7 days after surgery. Data were analyzed by Mann-Whitney U test and presented as median (25th- 75th percentiles).

There was no statistically significant differences in the IL-6 and IL-1beta concentrations throughout the study. At 6 and 24 hours the pain severity of according to VAS was higher in the control group at rest and on coughing during all study stages. We found no correlation between the level of pain and plasma concentrations of IL-1beta and IL-6. The plasma concentration of CRP in the control group was higher at 24 hours and at 7 days after surgery: (P < 0.01). Level of CRP in the control group tended to increase during the observation period.

In our study, the serum concentration of IL-6 and IL-1beta did not depend on the method of postoperative pain management. Using the ERAS protocol reduced postoperative plasma concentration of CRP. The increased level of CRP in the control group may be related with autoimmune reaction in wound due to delayed mobilization of patients.