Description and Comparison of Acute Pain Characteristics After Laparoscope-Assisted Vaginal Hysterectomy, Laparoscopic Myomectomy and Laparoscopic Adnexectomy

Figures & data

Figure 1 Recruitment flowchart, showing numbers of patients recruited by type of surgery and those lost up until the times of the follow-up visit in the first and second days.

Abbreviations: LAVH, laparoscope-assisted vaginal hysterectomy; LM, laparoscopic myomectomy; LA, laparoscopic adnexectomy.

Table 1 Demographic and Patient Characteristics for Laparoscope-Assisted Vaginal Hysterectomy, Laparoscopic Myomectomy and Laparoscopic Adnexectomy

Variables	LAVH	LM	LA	P value
Age (year)	49.0±6.8*^#	41.9±5.5	39.1±12.1	<0.001
Medical Insurance Type				<0.001
No	19 (7.63)	30 (14.29)	55 (26.19)
New Type Of Rural	172 (69.08)	106 (50.48)	77 (36.67)
Cooperative
Urban Residents	8 (3.21)	64 (30.48)	4 (1.90)
Urban Workers	50 (20.08)	10 (4.76)	74 (35.24)
Education				<0.001
Illiteracy	63 (25.30)	20 (9.52)	23 (10.95)
Primary School	106 (42.57)	69 (32.86)	47 (22.38)
Middle And High School	65 (26.10)	88 (41.90)	86 (40.95)
College And Higher	15 (6.02)	33 (15.71)	54 (25.71)
Occupation				<0.001
No	148 (59.44)	75 (35.71)	72 (34.29)
Yes	101 (40.56)	135 (64.29)	138 (65.71)
Hypertension				<0.001
No	202 (81.12)	200 (95.24)	189 (90.00)
Yes	47 (18.88)	10 (4.76)	21 (10.00)
Diabetes				0.014
No	235 (94.38)	208 (99.05)	203 (96.67)
Yes	14 (5.62)	2 (0.95)	7 (3.33)
A History Of Abdominal Surgery				0.075
No	182 (73.09)	147 (70.00)	136 (64.76)
Yes	67 (26.91)	63 (30.00)	74 (35.24)
BMI (kg/m^2)	23.56±2.88*^#	22.87±2.84	22.57±4.06	<0.001
Chief Complaint				<0.001
Physical Examination	157 (63.05)	129 (61.43)	138 (65.71)
Descensus Uteri	11 (4.42)	75 (35.71)	29 (13.81)
Changes In Menstruation	60 (24.10)	6 (2.86)	43 (20.48)
Dysmenorrhea	21 (8.43)	0 (0.00)	0 (0.00)
Preoperative Chronic Pain				0.002
No	176 (70.68)	168 (80.00)	174 (82.86)
Yes	73 (29.32)	42 (20.00)	36 (17.14)
Exercise Habit				0.185
No	189 (75.90)	169 (80.48)	174 (82.86)
Yes	60 (24.10)	41 (19.52)	36 (17.14)
The Level Of Anxiety				<0.001
No or Mild	182 (73.09)	198 (94.29)	201 (95.71)
Moderate	41 (16.47)	12 (5.71)	9 (4.29)
Severe	26 (10.44)	0 (0.00)	0 (0.00)
Pelvic Adhesions				<0.001
No	162 (65.06)	188 (89.52)	154 (73.33)
Yes	87 (34.94)	22 (10.48)	56 (26.67)
The Number Of Trocar				<0.001
Three	113 (45.38)	44 (20.95)	51 (24.29)
≥Four	136 (54.62)	166 (79.05)	159 (75.71)
Uterine Size				<0.001
Atrophy	31 (12.45)	0 (0.00)	25 (11.90)
Normal	21 (8.43)	35 (16.67)	168 (80.00)
≤13 gestational weeks	92 (36.95)	96 (45.71)	17 (8.10)
13–26 gestational weeks	105 (42.17)	79 (37.62)	0 (0.00)
Bleeding volume	20 (20–50)	20 (20–50)	10 (10–20)	0.247
Operative time	92.02±35.25*^#	84.55±36.11	73.75±40.94	0.041
Post-Operative Nausea And Vomiting				0.255
No	169 (67.87)	144 (68.57)	161 (76.67)
Only Nausea	25 (10.04)	18 (8.57)	14 (6.67)
Vomiting	55 (22.09)	48 (22.86)	35 (16.67)
Time Of Pelvic Drainage				<0.001
1 Day	193 (77.51)	179 (85.24)	171 (81.43)
2 Days	42 (16.87)	20 (9.52)	25 (11.90)
≥3 Days	14 (5.62)	11 (5.24)	14 (6.67)
The Urinary Catheter Time				<0.001
≤ 1 Day	40 (16.06)	160 (76.19)	180 (85.71)
2 Days	102 (40.96)	30 (14.29)	18 (8.57)
≥3 Days	106 (42.57)	20 (9.52)	12 (5.71)
Volume of pelvic drainage in 24 h	80 (50–145)	100 (40–170)	60 (0–150)	<0.001

Notes: Data were presented as n (%) or mean±standard deviation. *P<0.05 compared with LA; ^#P<0.05 compared with LM.

Table 2 Incidence of Different Types of Postoperative Pain of Laparoscope-Assisted Vaginal Hysterectomy

Type of Pain	No (n, %)	Mild (n, %)	Moderate (n, %)	Severe (n, %)	Mean
Visceral pain	26 (10.4)	110 (44.2)	64 (25.7)	49 (19.7)	3.77
Incision pain	74 (29.7)	116 (46.6)	53 (21.3)	6 (2.4)	1.86
Low back pain	61 (24.5)	99 (39.8)	53 (21.3)	36 (14.5)	3.06
Shoulder pain	211 (84.7)	26 (10.4)	5 (2.0)	7 (2.8)	0.55

Note: Values were presented as n (%).

Table 3 Incidence of the Moderate to Severe Pain Following Laparoscope-Assisted Vaginal Hysterectomy

	Number	Incidence (%)
0 type of moderate to severe pain	67	26.9
1 type of moderate to severe pain	105	42.2
2 types of moderate to severe pain	65	26.1
3 types of moderate to severe pain	10	4.0
4 types of moderate to severe pain	2	0.8

Notes: The 4 types of pain were: visceral pain, incisional pain, low back pain, shoulder pain.

Table 4 Incidence of Different Types of Postoperative Pain of Laparoscopic Myomectomy

Type of Pain	No (n, %)	Mild (n, %)	Moderate (n, %)	Severe (n, %)	Mean
Visceral pain	48 (22.9)	76 (36.2)	46 (21.9)	40 (19.0)	3.32
Incision pain	49 (23.3)	129 (61.4)	23 (11.0)	9 (4.3)	2.22
Low back pain	84 (40.0)	70 (33.3)	33 (15.7)	23 (11.0)	2.40
Shoulder pain	162 (77.1)	31 (14.8)	15 (7.1)	2 (1.0)	0.74

Note: Values were presented as n (%).

Table 5 Incidence of the Moderate to Severe Pain Following Laparoscopic Myomectomy

	Number	Incidence (%)
0 type of moderate to severe pain	82	39.0
1 type of moderate to severe pain	75	35.7
2 types of moderate to severe pain	44	21.0
3 types of moderate to severe pain	8	3.8
4 types of moderate to severe pain	1	0.5

Note: The 4 types of pain were: visceral pain, incisional pain, low back pain, shoulder pain.

Table 6 Incidence of Different Types of Postoperative Pain of Laparoscopic Adnexectomy

Type of Pain	No (n, %)	Mild (n, %)	Moderate (n, %)	Severe (n, %)	Mean
Visceral pain	104 (49.5)	71 (33.8)	26 (12.4)	9 (4.3)	1.64
Incision pain	41 (19.5)	145 (69.0)	24 (11.4)	0 (0)	2.21
Low back pain	130 (61.9)	47 (22.4)	30 (14.3)	3 (1.4)	1.27
Shoulder pain	164 (78.1)	30 (14.3)	16 (7.6)	0 (0)	0.70

Note: Values were presented as n (%).

Table 7 Incidence of the Moderate to Severe Pain Following Laparoscopic Adnexectomy

	Number	Incidence (%)
0 type of moderate to severe pain	128	61.0
1 type of moderate to severe pain	59	28.1
2 types of moderate to severe pain	20	9.5
3 types of moderate to severe pain	3	1.4
4 types of moderate to severe pain	0	0.0

Notes: The 4 types of pain were: visceral pain, incisional pain, low back pain, shoulder pain.

Table 8 Comparison Between Laparoscope-Assisted Vaginal Hysterectomy, Laparoscopic Myomectomy and Laparoscopic Adnexectomy

	LA	LM	LAVH	F	P
0 type of moderate to severe pain	128 (61%)	82 (39%)	67 (26.9%)	55.13	<0.001
At least 1 type of moderate to severe pain	82 (39%)	128 (61%)	182 (73.1)	55.13	<0.001
Highest pain scores during the 48 h after surgery	3.45 (1.77)	4.69 (2.41)	5.03 (2.41)*^#	30.09	<0.001
Opioid consumption during surgery (mg)	11.28 (2.02)	11.43 (1.42)	11.78 (1.43)*	5.58	0.004
The number of opioid users in the PACU	11 (5.2%)	23 (11%)	31 (12.4%)	7.29	0.03
The number of indomethacin users	69 (32.9%)	23 (11%)	95 (38.2%)	45.5	<0.001
The number of pethidine users	2 (1.0%)	0 (0%)	12 (4.8%)	14.86	<0.001
The total consumption of opioids (mg)	11.51 (2.32)	11.80 (1.85)	12.41 (2.43)*	9.83	<0.001

Notes: Data were presented as n (%) or mean±standard deviation. *P<0.05 compared with LA; ^#P<0.05 compared with LM.