Less postoperative pain after laparoscopic hysterectomy than after vaginal hysterectomy

Pokkinen, Satu M.; Kalliomäki, Maija-Liisa; Yli‐Hankala, Arvi; Nieminen, Kari

doi:10.1007/s00404-014-3608-7

Cited by 14 publications

(10 citation statements)

References 16 publications

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“…Contrary to the findings of this study, several studies have reported significantly lower postoperative pain in the vNOTES group than in the laparoscopy group [2,4,8,13]. On the other hand, previous studies that evaluated postoperative pain between laparoscopic and vaginal hysterectomy have reported higher postoperative pain in vaginal hysterectomy [12,14]. Although vaginal hysterectomy had been generally considered the most minimally invasive surgery and with the least postoperative pain, these studies showed higher postoperative pain after vaginal hysterectomy.…”

Section: Discussioncontrasting

confidence: 99%

Comparison of Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) and Laparoendoscopic Single-Site (LESS) Hysterectomy on Postoperative Pain Reduction: A Randomized Pilot Study

2021

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Introduction: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy has shown benefit in postoperative pain and operation time compared to laparoscopic hysterectomy in recent studies. However, no prospective studies comparing laparoendoscopic single-site (LESS) and vNOTES hysterectomy have been performed. This study aims to evaluate postoperative pain and safety of vNOTES hysterectomy compared to LESS hysterectomy for benign uterine disease. Methods: This study is a prospective, investigator-initiated randomized controlled pilot trial. A total of 26 patients were randomized and allocated to vNOTES group (n = 13) and LESS group (n = 13). The primary outcome was postoperative abdominal and vaginal pain evaluated 24 h after surgery. Secondary outcomes included the number of additional analgesics administered and the maintenance rate of patient-controlled analgesia (PCA). Results: No differences were shown in baseline characteristics between the two groups. Operation time was longer in the LESS group (median, 55 vs. 75 min; P = 0.027), and there were no differences in estimated blood loss, postoperative hemoglobin level, surgical indications, and hospitalization days. Postoperative abdominal pain intensity did not differ between the two groups, while the vNOTES group showed higher postoperative vaginal pain than the LESS group at 16 and 24 h after surgery (median, 3 vs. 1 and 2 vs. 0, P = 0.007 and P = 0.010, at 16 and 24 h respectively). No differences were shown in the number of additional analgesics and PCA use between the two groups. Conclusions: vNOTES hysterectomy can be safely performed for benign uterine disease requiring hysterectomy. However, vNOTES hysterectomy might be associated with higher postoperative vaginal pain intensity compared to LESS hysterectomy. TrialRegistration: CRIS identifier KCT0004605.

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Section: Discussioncontrasting

confidence: 99%

Comparison of Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) and Laparoendoscopic Single-Site (LESS) Hysterectomy on Postoperative Pain Reduction: A Randomized Pilot Study

2021

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“…Other strengths of this study were that we included only laparoscopy patients and that intraoperative care was standardised. This was important as surgical technique and anaesthetic regimen may affect the severity of postoperative pain and adverse effects in gynaecological surgery …”

Section: Discussionmentioning

confidence: 43%

Analgesic efficacy and pharmacokinetics of epidural oxycodone in pain management after gynaecological laparoscopy—A randomised, double blind, active control, double‐dummy clinical comparison with intravenous administration

Piirainen

Kokki

Anderson

et al. 2019

Brit J Clinical Pharma

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Aims: Early pain after laparoscopy is often severe. Oxycodone is a feasible analgesic option after laparoscopy, but there are sparse data on epidural administration. The aim was to evaluate the analgesic efficacy and pharmacokinetics of a single dose of epidural oxycodone as a part of multimodal analgesia after gynaecological laparoscopy. Methods: Women (n = 60), aged 23-71 years, undergoing elective gynaecological laparoscopy, were administrated either epidural oxycodone 0.1 mg kg −1 and intravenous (i.v.) saline (EPI-group n = 31), or epidural saline and i.v. oxycodone 0.1 mg kg −1 (IV-group = 29) in a randomised, double blind, active control, double dummy clinical trial. A pharmacokinetic model was developed using population modelling of plasma and cerebrospinal fluid (CSF) concentrations obtained in these patients and data of 2 published studies. The primary outcome was the amount of i.v. fentanyl for rescue analgesia during the first 4 hours. Results: Twenty of the 31 patients in the EPI-group and 26 of the 29 patients in the IV-group needed i.v. fentanyl for rescue analgesia, P = .021. The median (interquartile range) number of fentanyl doses were 1.0 (1.0-3.0) in the EPI-group and 2.5 (1.0-4.0) doses in the IV-group, P = .008. Plasma concentrations were similar, but CSF concentrations were 100-fold higher in the EPI-group. The population model indicated that 60% of oxycodone injected into the epidural space enters into CSF and 40% is absorbed into the systemic circulation. Conclusions:The data support superiority of epidural administration of oxycodone compared to i.v. administration during the first hours after laparoscopic surgery. This is likely to be based on enhanced permeation into the central nervous system after epidural administration.

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“…The type of surgery, laparoscopic or vaginal, may affect the severity of postoperative pain, but the type of anaesthesia, i.e. inhalation or intravenous, seems not to affect oxycodone consumption in hysterectomy patients [101,102].…”

Section: Oxycodone In Patients Undergoing Laparoscopic Versus Open Sumentioning

confidence: 99%

Updated Clinical Pharmacokinetics and Pharmacodynamics of Oxycodone

et al. 2019

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Global oxycodone consumption has increased sharply during the last two decades, and, in 2008, oxycodone consumption surpassed that of morphine. As oxycodone was synthesized in 1916 and taken to clinical use a year later, it has not undergone the same approval process required by today's standards. Most of the basic oxycodone pharmacokinetic (PK) data are from the 1990s and from academic research; however, a lot of additional data have been published over the last 10 years. In this review, we describe the latest oxycodone data on special populations, including neonates, children, pregnant and lactating women, and the elderly. A lot of important drug interaction data have been published that must also be taken into account when oxycodone is used concomitantly with cytochrome P450 (CYP) 3A inducers and inhibitors and/or CYP2D6 inhibitors. In addition, we gathered data on abuse-deterrent oxycodone formulations, and the PK of alternate administration routes, i.e. transmucosal and epidural, are also described. Mari Kinnunen and Panu Piirainen contributed equally to this work.

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Less postoperative pain after laparoscopic hysterectomy than after vaginal hysterectomy

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

Cited by 14 publications

References 16 publications

Comparison of Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) and Laparoendoscopic Single-Site (LESS) Hysterectomy on Postoperative Pain Reduction: A Randomized Pilot Study

Comparison of Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) and Laparoendoscopic Single-Site (LESS) Hysterectomy on Postoperative Pain Reduction: A Randomized Pilot Study

Analgesic efficacy and pharmacokinetics of epidural oxycodone in pain management after gynaecological laparoscopy—A randomised, double blind, active control, double‐dummy clinical comparison with intravenous administration

Updated Clinical Pharmacokinetics and Pharmacodynamics of Oxycodone

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