Risk factors of different types of acute pain after laparoscope-assisted vaginal hysterectomy

Abstract

Purpose: Previous study has shown that acute pain after laparoscope-assisted vaginal hysterectomy (LAVH), which consists of several pain components, like somatic pain, visceral pain, shoulder pain, and low back pain (LBP). Potential risk factors of postoperative pain remain unclear. This study aimed to determine risk factors for different types of acute postoperative pain and provide guidance for personalized analgesic medication programs. Patients and methods: This was a prospective, observational cohort study, in which 287 patients undergoing LAVH between January, 2017 and September, 2018 at the First Affiliated Hospital of Wenzhou Medical University, China were included. Univariate and multivariable logistic regression analyses were used to evaluate risk factors for the different types of acute pain after LAVH. Results: In the total cohort, visceral pain and LBP were the most common complaints of patients, followed by somatic pain and shoulder pain. Multivariable analysis revealed that postoperative nausea and vomiting, BMI and main indication for surgery were associated with acute postoperative visceral pain. Preoperative chronic pain, BMI, preoperative anxiety and the number of trocars were associated with acute postoperative LBP, while occupation, pelvic adhesions, and history of abdominal surgery were risk factors for acute postoperative somatic pain. Conclusion: Our study highlights that acute postoperative visceral pain and LBP are main components of pain after LAVH, and different types of acute pain after LAVH are correlated with preoperative, intraoperative and postoperative factors. Acute postoperative pain has unique risk factors according to the component type.