Modern methods for evaluating acute and chronic pain after abdominal hysterectomy

Abstract

Background. Pain after abdominal hysterectomies is a common clinical problem. It can be both acute and chronic and affects up to 30 % of patients after surgery. The purpose of our study was to determine the frequency of acute pain in the first 3 days and to evaluate the risk of developing chronic neuropathic pain 30 and 60 days after total abdominal hysterectomy. Materials and me­thods. A prospective cohort single-center study in parallel groups was conducted. It included 52 women divided into group I (n = 24) and group II (n = 28). In both groups, combined anesthesia was used with no differences between groups in terms of the component of general anesthesia, but it differed in the component of regional anes­thesia: group I received epidural anesthesia with catheterization, while group II — bilateral QL-block. In all patients dexketoprofen was used as a preemptive component of analgesia, and as a postope­rative analgesia, a combination of paracetamol and dexketoprofen was administered for 2 days; in acute severe pain — morphine 10 mg parenterally. Patients from group I received prolonged epidural analgesia with 0.2% bupivacaine solution via catheter in the first 2 days after surgery. Study stages: 24 hours (d1), 48 hours (d2), 72 hours (d3), 30 days (d30) and 60 days (d60) after surgery. Results. No significant differences in pain severity on visual analog scale were found on stages d1 and d2 for both groups. However, on stage d3, this parameter was significantly higher in group II compared to I group: 4.1 ± 0.2 points and 1.8 ± 0.1 points, respectively (p < 0.05). The frequency of acute severe pain in group I was 12.5 % on stage d1, 4.2 % on stage d2 and 0 % on stage d3; in group II, these indicators were 21.4, 17.9 and 7.1 %, respectively. The risk of chronic neuropathic pain among patients of both groups was quite high. In particular, on stage d30, in group I it was 5 [4; 6] points, in group II — 6 [5; 6] points (p ≥ 0.05), and on stage d60, 5 [4; 5], and 5 [4; 5] points, respectively (p ≥ 0.05). Conclusions. The incidence of acute severe pain did not have significant differences between patients of both groups on d1, d2 and d3 stages and decreased from 12.5 and 21.4 % in groups I and II, respectively, on stage d1 to 4.2 and 17.9 % on stage d2 and to 0 and 7.1 % on stage d3. The risk of chronic neuropathic pain on study stage d30 in group I of patients was 5 [4; 6] points, in group II — 6 [5; 6] points (p ≥ 0.05), and on stage d60, it was 5 [4; 5] and 5 [4; 5] points, respectively (p ≥ 0.05).

Keywords

• hysterectomy
• acute pain
• chronic pain
• regional anes­thesia