Patterns, Outcomes, and Complications of Postoperative Analgesia in Major Gynecologic Surgery
Postoperative Analgesia in Major Gynecologic Surgery
Keywords:
Postoperative Pain; Analgesia, Epidural; Analgesics, Opioid; Pain Management; Gynecologic Surgical Procedures.Abstract
Background:
This study aimed to evaluate pain intensity, analgesic practices, complication rates, and patient satisfaction among women undergoing major gynecological surgeries.
Methods:
A prospective observational study was conducted at Hayatabad Medical Complex, Peshawar, Pakistan, from January to June 2023. A total of 211 women undergoing elective gynecological surgeries were included. Analgesic modalities compared included intravenous (IV) opioid infusion, patient-controlled intravenous analgesia (PCIA), and epidural analgesia. Pain scores were recorded using the Numeric Rating Scale (NRS) at predefined intervals, and complications were documented. Chi-square tests and descriptive statistics were used (p < 0.05 considered significant).
Results:
PCIA was the most commonly used modality (n = 125, 59.2%), followed by IV opioids (n = 58, 27.5%) and epidural infusion (n = 28, 13.3%). Moderate-to-severe breakthrough pain (NRS ≥4) was observed in 49.3% of patients using PCIA, 56.9% using IV opioids, and 14.3% using epidural (χ² = 11.27, p = 0.004). Vomiting occurred in 10 (17.2%) patients receiving IV opioids, 8 (6.4%) in the PCIA group, and none in the epidural group (χ² = 9.02, p = 0.011). Overall complication rates were 31.0% in the IV opioid group, 20.0% in PCIA, and 3.6% in epidural (χ² = 10.99, p = 0.012). Epidural analgesia showed the lowest mean pain scores at 30 minutes (1.2 static, 2.8 dynamic).
Conclusion:
Epidural analgesia provides superior early pain relief with fewer complications. Enhancing access to regional techniques and organizational support is essential for improving postoperative outcomes in gynecological surgery.
