Abdominal hysterectomy and postoperative Pain: A multimodal strategy to overcome the challenge
Keywords:
ANALGESIA; HISTERECTOMÍA; DOLOR POSTOPERATORIO.; ANALGESIA; HYSTERECTOMY; PAIN, POSTOPERATIVE.; ANALGESIA; HISTERECTOMIA; DOR PÓS-OPERATÓRIA.Abstract
Introduction: hysterectomy is one of the most frequently performed gynecological surgeries worldwide, with a high incidence of postoperative pain that increases morbidity. Currently, multimodal analgesia is recommended as a strategy for its control.
Objective: to describe the results obtained with the use of multimodal analgesia in patients undergoing abdominal hysterectomy.
Methods: a longitudinal descriptive observational study was conducted from December 2021 to November 2022 at the Julio Trigo López Clinical Surgical Teaching Hospital. The study included a universe of 130 patients who underwent abdominal hysterectomy. Ketamine infusion, sodium diclofenac, and infiltration of the surgical wound with 0,25 % bupivacaine were used. Pain intensity was assessed using a visual analog scale during the first four hours of the immediate postoperative period. The need for rescue analgesia and adverse effects associated with the multimodal technique were evaluated.
Results: at the end of the first four hours, no patient reported severe pain. In the third and fourth hours, 6,9 % and 31,5 % of patients, respectively, reported mild pain; 6,9 % and 19,3 % reported moderate pain, respectively. The requirements for rescue analgesics were minimal: 6,9 % in the third hour and 19,2 % in the fourth hour. Only 10 % of patients experienced nausea and vomiting.
Conclusions: multimodal analgesia demonstrated adequate control of acute postoperative pain in abdominal hysterectomy, with minimal adverse events and reduced need for rescue analgesia.
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