A study of menstrual cycle effects on pain perception, haemodynamic response to laryngoscopy, and postoperative outcome in gynaecological laparoscopy

Abstract

Background The physiological alterations that occur during the females’ reproductive age due to hormonal fluctuations throughout the menstrual cycle may affect the perioperative period and impact the postoperative outcome. This study evaluated the impact of menstrual cycle phases on pain perception, haemodynamic response to laryngoscopy, postoperative agitation, nausea, and vomiting in women undergoing laparoscopic gynaecological procedures.Methods This prospective observational study included 60 women who were randomly assigned to have diagnostic gynaecological laparoscopy during their menstrual cycle’s luteal or follicular phases. Patients were divided into two groups: follicular and luteal group. Preoperatively a blood sample was withdrawn for measurement of norepinephrine, estradiol, and progesterone levels. Anaesthetic techniques were standardized in both groups. In the postoperative period, another blood sample was withdrawn from all patients and sent for norepinephrine measurement.Before induction of anaesthesia, baseline HR, SBP, DBP, and MAP were measured. Then, following endotracheal intubation at 1, 3 and 5 minutes. Pain perception was assessed using Numerical Rating Scale (NRS); in response to IV cannulation, then postoperative abdominal pain and shoulder referred pain were assessed every 15 minutes till the end of 1st hour, then every 6 hours till discharge. The incidence of postoperative nausea and vomiting was recorded at the same time points of pain assessment. Postoperative agitation was assessed using Richmond Agitation-Sedation Scale (RASS).Results Women in the follicular phase showed higher postoperative pain, higher incidence of postoperative nausea, and more increase in HR and delayed return to baseline value post tracheal intubation as compared to luteal phase.

Keywords

• Menstrual cycle
• postoperative pain
• postoperative nausea and vomiting
• norepinephrine
• haemodynamic response to laryngoscopy
• postoperative agitation