A prospective Pain Survey in the Second Postoperative Day after Total Abdomial Hysterectomy

Abstract

Background:  Most of gynecological patients were encourage to ambulate after 24 hr of surgery.  For this reason, after a total abdominal hysterectomy, care providers are reluctant to give a strong analgesic after the first postoperative day, except oral acetaminophen.  Pain patients are experiencing the second postoperative day at our hospital has not been graded.

Objective:  To determine the incidence and magnitude of pain during  the second post-operative day after total abdominal hysterectomy.

Design:  Descriptive study.

Setting:  Gynecological Ward at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University between October 4 and December 7, 2004.

Method:  The  patients  were  interviewed on the second post-operative day  after total abdominal hysterectomy.

Outcome Measures:  Pain and suffering scores were evaluated both at rest and during ambulation (both using a numeric rating scale 0-10, scores > 5 defined moderate to severe pain). We recorded pain intensity and relief before and after taking oral acetaminophen, numbers of analgesic injection(s) during the 24 hours after surgery, the time between the last analgesic injection and the first oral acetaminophen, the need for analgesic injection(s)during the second post-operative day, and patients' satisfaction with pain relief.

Results:  Forty-five patients were interviewed: 69% (95% CI 51–79%) had moderate to severe pain and 67% suffering while ambulating. Before receiving the first oral acetaminophen, 86% had moderate to severe pain and 84% suffering; afterward the pain and suffering were reduced to 38 and 37%, respectively.  Twenty-eight percent of the participants felt that oral acetaminophen provided modest pain relief, while 42% needed more analgesic on  the second post-operative day.  Most of the patients (92%) were satisfied with the pain relief given even though they still experienced pain.

Conclusion:  On  the second post-operative day after a total abdominal hysterectomy, 69% of women had moderate to severe pain and 67% suffering while ambulating: 28% reported oral acetaminophen produced modest pain relief.  Although most of the patients were satisfied with the received treatment, alternative methods should be used for greater reduction of pain and suffering.

Key words:  Pain, suffering, total abdominal hysterectomy, ambulation