Less postoperative pain after laparoscopic hysterectomy than after vaginal hysterectomy

To find out whether the severity of acute postoperative pain differs between laparoscopic (LH) or laparoscopically assisted vaginal hysterectomy (LAVH) and vaginal hysterectomy.

In a prospective, powered, non-randomized trial, the consumption of oxycodone and pain scores were evaluated in 164 women up to 20 h after VH or LH/LAVH. All hysterectomies were performed under standardized general anesthesia and the pain medication was similar in both groups. The primary endpoint was the cumulative oxycodone consumed. Main secondary endpoints were pain scores (numeric rating scale NRS), operative time and hospital stay.

The patients in LH/LAHV group consumed less opioid than the patients in the vaginal group during the 20 h period after surgery. The difference was significant at time point 4 and 6 h. The oxycodone consumed at time point 4 h was 19.9 (95 % CI 18.1-21.7) mg in laparoscopic group and 22.8 (20.7-25.0) mg in vaginal group (p = 0.040) and at time point 6 h was 23.5 (21.5-25.6) mg in laparoscopic group and 27.4 (24.7-30.0) mg in vaginal group (p = 0.026). Pain scores were lower after laparoscopic approach and the difference was significant at time point 60 min after surgery (p = 0.026).

In this study, LH was associated with reduced need of analgesics and lower acute postoperative pain scores than VH.