Preemptive analgesia for postoperative hysterectomy pain control

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Preemptive analgesia for postoperative hysterectomy pain control
Key Take-Away: 

Postoperative pain is experienced by women that undergo total abdominal hysterectomy. In this guideline and systematic review, the efficacy of different preemptive analgesics for controlling postoperative has been determined and compared by pain assessment scores.

The objective of the study was to investigate the effectiveness of preemptive analgesia at pain control in women undergoing total abdominal hysterectomy. 

ABSTRACT: 
Background: 

The objective of the study was to investigate the effectiveness of preemptive analgesia at pain control in women undergoing total abdominal hysterectomy.

Eligible studies, published through May 31, 2016, were retrieved through Medline, Cochrane Central Register for Controlled Trials, and Cochrane Database of Systematic Reviews.

Methods: 

We included randomized controlled trials with the primary outcome of pain control in women receiving a preemptive medication prior to total abdominal hysterectomy.

Comparators were placebo, different doses of the same medication as intervention, or other nonnarcotic or narcotic medication. Study data were extracted by one reviewer and confirmed by a second reviewer. For each outcome we graded the quality of the evidence. Studies were classified by the type of medication used and by outcome type.

Results: 

Eighty-four trials met eligibility, with 69 included.

Among nonnarcotic medications, paracetamol, gabapentin, and rofecoxib combined with gabapentin resulted in improvements in pain assessment compared with placebo and other nonnarcotic medications. Patient satisfaction was higher in patients who were given gabapentin combined with paracetamol compared with gabapentin alone. Use of preemptive paracetamol, gabapentin, bupivacaine, and phenothiazine resulted in less narcotic usage than placebo. All narcotics (ketamine, morphine, fentanyl) resulted in improved pain control compared with placebo. Narcotics had a greater reduction in pain assessment scores compared with nonnarcotics, and their use resulted in lower total narcotic usage.

Conclusion: 

Preemptive nonnarcotic and narcotic medications prior to abdominal hysterectomy decrease total narcotic requirements and improve patient postoperative pain assessment and satisfaction scores.

Source:

American Journal of Obstetrics and Gynecology

Link to the source:

http://www.ajog.org/article/S0002-9378(17)30424-6/fulltext?rss=yes

Original title of article:

Preemptive analgesia for postoperative hysterectomy pain control: Systematic review and clinical practice guidelines

Authors:

Adam C. Steinberg et al

American Journal of Obstetrics and Gynecology
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