Pain after endometriosis surgery: a retrospective cohort study
Lilian Ihrman1, Gabriella Jönsson2, Mikael Wallin Angelin1
1Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden.
Objective:
Postoperative pain after endometriosis surgery has not been widely investigated, although these patients often present complex pain mechanisms. This study aimed to characterize postoperative pain and analgesic management in patients undergoing intra-abdominal endometriosis surgery at Skåne University Hospital Malmö (Sweden).
Methods:
Background, surgical, anesthetic and intra- and postoperative data were collected from records of patients who underwent intra-abdominal endometriosis surgery between 2021 and 2025. The primary endpoint was the Numeric Rating Scale (NRS) for pain at admission to the Post-Anesthesia Care Unit (PACU). Secondary endpoints included NRS at PACU discharge, opioid use intraoperatively and in the PACU, and the need for pain therapy three weeks postoperatively. Descriptive statistics and regression models were used. Subgroup analyses compared pain in hysterectomy vs. other procedures and the analgesic effect of preemptive spinal analgesia in hysterectomy patients.
Results:
A total of 155 patient's records were examined. More than half of patients reported an NRS>3 at PACU admission, median value 5 (IQ1-IQ3: 0-7). Median opioid consumption in the PACU was 9 (0-21) mg oral morphine equivalents (OME), while median intraoperative administration was 57 (14-90) OME mg. Fifty percent of the patients still required pain therapy three weeks after surgery and 14 % sought emergency care for abdominal pain not related to surgical complication within a month from discharge. Persistent pain at three weeks was associated with preoperative pain and the need for in-hospital pain service, but not with PACU NRS or opioid use. Hysterectomy patients required more opioids and longer PACU time, and preemptive spinal analgesia was associated with less need for pain therapy at three weeks after hysterectomy.
Conclusions:
Persistent postoperative pain is common after endometriosis surgery. Preoperative pain history and the involvement of a pain specialist during admission predicted persistent pain at three weeks after surgery better than PACU pain intensity alone.
