Patterns, Outcomes, and Complications of Postoperative Analgesia in Major Gynecologic Surgery

Postoperative Analgesia in Major Gynecologic Surgery

Abstract

Objective: This study aimed to evaluate the extent of pain, analgesic use, complications, and patient satisfaction among women undergoing major gynaecological operations. Study Design: Prospective observational study. Settings: Hayatabad Medical Complex, Peshawar, Pakistan. Duration: January to June 2023. Methods: A total of 211 women undergoing elective gynaecological surgeries. Different analgesic modalities—intravenous opioid infusion, patient-controlled intravenous analgesia (PCIA), and epidural analgesia were compared. Pain was assessed using the Numeric Rating Scale (NRS) at defined intervals, and associated complications were also recorded. Results: The most frequent modality was PCIA (n = 125, 59.2%), next came IV opioids (n = 58, 27.5), and lastly epidural infusion (n = 28, 13.3%). The 49.3% of patients using PCIA, 56.9% using IV opioids, and 14.3% using epidural showed moderate to severe breakthrough pain (NRS 4 or higher) (χ 2 = 11.27, p = 0.004). The incidence of vomiting was 10 (17.2) and 8 (6.4) in IV opioids and PCIA groups, respectively, and no incidence in the epidural group (2 = 9.02, p = 0.011). The total rates of complications amounted to 31.0 in the IV opioid arm, 20.0 in PCIA, and 3.6 in epidural (2 = 10.99, p = 0.012). Conclusion: Epidural analgesia is a better method with fewer complications for early pain relief. To improve the outcome of gynecological surgery postoperatively, it is necessary to enhance access to regional methods and organizational assistance.