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Laparoscopically assisted vaginal and abdominal hysterectomy: comparison of postoperative pain, fatigue and systemic response. A case-control study

Published online by Cambridge University Press:  16 August 2006

M. G. F. Rorarius
Affiliation:
Department of Anaesthesia and Intensive Care, University of Tampere, Finland Institute of Clinical Medicine, University of Tampere, Finland
E. Kujansuu
Affiliation:
Department of Obstetrics and Gynaecology, University of Tampere, Finland
G. A. Baer
Affiliation:
Department of Anaesthesia and Intensive Care, University of Tampere, Finland Institute of Clinical Medicine, University of Tampere, Finland
P. Suominen
Affiliation:
Department of Anaesthesia and Intensive Care, University of Tampere, Finland
K. Teisala
Affiliation:
Department of Obstetrics and Gynaecology, University of Tampere, Finland
A. Miettinen
Affiliation:
Department of Microbiology, University of Tampere, Finland
P. Ylitalo
Affiliation:
Department of Pharmacology University of Tampere, Finland
P. Laippala
Affiliation:
Department of Biometrics, Medical School, University of Tampere, Finland
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Abstract

Background and objective Laparoscopic and open surgery have been compared with conflicting results regarding their systemic responses. The sensitivity of biochemical markers that are used to discriminate between the stress responses to different types of surgery varies from study to study. We wanted to evaluate the stress response and the sensitivity of clinical and biochemical stress markers in patients undergoing laparoscopically assisted vaginal or abdominal hysterectomy.

Methods We performed a case-control study with patients undergoing laparoscopically assisted vaginal hysterectomy (n=20) or abdominal hysterectomy (n=20). Pain scores were assessed at rest and during coughing, and active leg elevation and fatigue scores using a visual analogue scale. In 10 patients of each group, haematocrit, white cell count, C-reactive protein, glucose, cortisol, adrenocorticotrophic hormone, β-endorphin immunoreactivity, interleukin-6 and urine excretion of epinephrine and norepinephrine were measured preoperatively and during the first 44 postoperative hours.

Results The most sensitive symptoms and markers of the systemic response were pain scores during mobilization, fatigue scores, C-reactive protein and interleukin-6 (P < 0.01 in all comparisons). Pain scores at rest, and all other laboratory markers of the systemic response, did not discriminate between the two types of surgery.

Conclusion Follow-up of postoperative pain scores during mobilization and fatigue levels might be an easy tool for the evaluation of postoperative recovery. Using an identical anaesthetic technique, the neuroendocrine response was of the same magnitude after both types of surgery.

Type
Original Article
Copyright
2001 European Society of Anaesthesiology

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Laparoscopically assisted vaginal and abdominal hysterectomy: comparison of postoperative pain, fatigue and systemic response. A case-control study
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