The dominant component of pain after gynecologic laparoscopic surgery MD.Selçuk SELÇUK

Background Laparoscopic surgeries have many advantages as short incision decreased blood loss reduced hospital stay and pain I would like to thanks scientific commitie for giving us this chance to present our study. Todat i will present our study entitled as “The dominant component of pain after gynecologic laparoscopic surgery”

It is accepted that pain after laparoscopic surgery has two major components as parietal and visceral component. The parietal component is thought to be related to the incision at the port site, while the visceral component is associated with intervention of the visceral peritoneum in the surgical area, degree of inflammation, and distension of the intraabdominal cavity due to pneumoperitoneum.

Parietal pain was reported as the dominant component of postoperative pain after laparotomy. There is limited data related to the dominat component of postoperative pain after laparoscopy.

Aim To compare the intensity of the visceral and parietal component of the postoperative pain after gynecologic laparoscopic surgery.

Material & Method This prospective study was carried out at Zeynep Kamil Research and Teaching Hospital and 80 patients who underwent gynecologic laparoscopic surgery were enrolled into the study. Postoperative pain intensity was assessed by linear visual analogue scale (VAS) at postoperative 1st,2nd,6th and 24th hours. Postoperative pain intensity was evaluated in terms of visceral and parietal component by VAS.

Patients were asked to describe the intensity of the two components of postoperative pain as; parietal pain (incisional pain in the abdominal wall that the patient can touch) visceral pain (deep, dull, inside the abdomen) Postopertaive pain was assessed by using VAS at postoperatively 1st,2nd,6th and 24th the patient at rest.

Results Mean  sd Age (years) 39.34  10.33 Parity 1.68  1.70   Mean  sd Age (years) 39.34  10.33 Parity 1.68  1.70 BMI (kg/m2) 27.03  5.31 Duration of surgery (min) 60.38  23.69 No of 5 mm trocar 2.63  0.66 Length of postoperative hospital stay (hours after surgery) 28.80  10.39

Comparison of two component of postoperative pain 7.30  2.41 5.94  2.35 4.55  2.31 4.10  2.88 3.44  1.94 2.83  2.24 2.311.80 1.66  1.84

The visceral pain intensity was significantly higher than parietal pain intensity at postoperative 1st,2nd,6th and 24th hours (p<0.001).

Discussion The dominant cause of pain after laparoscopic surgery has also been assessed in different studies, with conflicting results. Most studies evaluating the dominant cause of pain have been carried out by general surgeons; there has not been sufficient assessment among patients undergoing laparoscopic gynecological surgery.

While some authors found the dominant cause of pain to be the visceral component , others stated that the parietal component was the dominant cause of pain. In our study we found that the dominant component of postoperative pain after laparoscopy is visceral component.

Our findings are consistent with the previous studies demonstrated that the dominant component of pain after laparoscopy was the visceral component rather than the parietal component. Helvacioglu A, Fertil Steril 1992 Joris J et al, Anesth Analg 1995 Cha SM et al, Journal of Surgical Research,2012

However our results showed differences from the results of study carried out by Bisgaard et al. The authors reported the dominant source of pain was the parietal component at the early postoperative time. Bisgaard T et al, Anesth Analg, 1999

The cause of different results between studies cannot be easily clarified. The various challenges associated with detecting the dominant cause of postoperative laparoscopic pain are subjectivity of degree and localization of pain by patients; number and properties of port site incisions; operation time; operation type; degree of visceral intervention; use of different coagulation methods and extension for homeostasis; and type of local anesthetic.

Conclusion The visceral pain after gynecologic laparoscopic surgery was found as dominant component of postoperative pain. To relieve the pain after gynecologic laparoscopic surgery; the interventions should be performed to decrease the visceral component of pain such as local anesthetic administration route, avoiding from unnecessary visceral peritoneum dissection.