What methods of pain relief are available following abdominal hysterectomy?

This is a very straightforward type of question in which ‘abdominal hysterectomy’ could be substituted by ‘laparotomy’, ‘total hip replacement’ or ‘thoracotomy’. Some of your answer can be a generic account of postoperative pain management, but you must focus also on the particular operative procedure that is cited.

Introduction

Abdominal hysterectomy is a common surgical procedure that is usually performed via a transverse subumbilical abdominal incision. In general the postoperative pain is moderate to severe, and it is complicated in as many as 70% of cases by nausea and vomiting. It is interesting that patients who have identical abdominal wounds following caesarean section are frequently mobilising on simple analgesics within 24 hours.

Analgesia options

• Patients undergoing abdominal hysterectomy are typically ASAI or II and may be well informed. The range of options, therefore, is wide and should be discussed in full with the patient. This is particularly important if regional analgesia is considered.

• Extradural analgesia via infusion or PCEA (patient controlled epidural analgesia)

1. — Low dose bupivacaine plus opioid represents (arguably) the optimal analgesic technique with reliable, flexible and continuous pain relief.

2. — Disadvantages include complications of the technique, reliance on expensive technology, increased immobility, and requirement (according to some authorities) for nursing in a high dependency area.