Nilsson Wesley, Narwold Elizabeth, Turner Lindsay, Shepherd Jonathan
Division of Gynecology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
University of Connecticut School of Medicine, Farmington, CT, USA.
Int Urogynecol J. 2025 May 10. doi: 10.1007/s00192-025-06162-6.
Many surgeons perform hysterectomy at the time of pelvic organ prolapse (POP) surgery if the uterus is present, but it is unknown how this impacts patient pain. The objective of this study was to compare POP surgeries with and without a hysterectomy for differences in post-operative pain using a visual analog scale (VAS), and morphine milligram equivalents (MME) at 24 h.
This was a secondary analysis of a randomized controlled trial comparing the impact of pre-operative intravenous acetaminophen with placebo on post-operative pain following POP surgery.
We included 202 subjects undergoing minimally invasive POP surgery. A concomitant hysterectomy was performed in 120 of the subjects (59.4%). Most were white (97.5%), had baseline POP-Q stage III prolapse (75%), and BMI 27.8 ± 4.3 kg/m, with no difference between groups. Those with concomitant hysterectomy were younger (64.2 ± 10.5 vs 67.5 ± 8.7 years, p = 0.02). Length of stay was 0.9 ± 0.5 days, and similar between groups (p = 0.24). Operative time was longer with concomitant hysterectomy (186.1 ± 52.7 vs 123.1 ± 47.2 min, p = 0.02). VAS scores 24 h post-operatively (hysterectomy = 3.0 ± 2.3, no hysterectomy = 2.7 ± 2.3, p = 0.49) and MMEs (51.4 ± 74.5 vs 37.1 ± 60.4, p = 0.15) were both similar. Patient-Reported Outcomes Measurement Information System scores measuring pain interference showed no difference between groups (22.9 ± 9.7 vs 20.9 ± 9.3, p = 0.21, possible range 8-40). Linear regression showed that concomitant hysterectomy did not impact 24-h VAS scores (adjusted beta = 0.113; p = 0.77) and showed no impact on 24-h MME (adjusted beta = 14.25; p = 0.15).
Although procedures were longer and patients were younger, with concomitant hysterectomy, there was no difference in 24-h VAS pain scores, 24-h MME opioid usage, or other pain metrics in POP surgeries with and without hysterectomy. Overall, opioid use and pain scores were low.
许多外科医生在盆腔器官脱垂（POP）手术时若子宫存在则会进行子宫切除术，但这对患者疼痛的影响尚不清楚。本研究的目的是使用视觉模拟量表（VAS）和术后24小时的吗啡毫克当量（MME），比较行子宫切除术和未行子宫切除术的POP手术在术后疼痛方面的差异。
这是一项随机对照试验的二次分析，该试验比较了术前静脉注射对乙酰氨基酚与安慰剂对POP手术后疼痛的影响。
我们纳入了202例行微创POP手术的受试者。其中120名受试者（59.4%）同时进行了子宫切除术。大多数为白人（97.5%），基线POP-Q分期为III度脱垂（75%），体重指数为27.8±4.3kg/m²，两组间无差异。同时进行子宫切除术的患者更年轻（64.2±10.5岁 vs 67.5±8.7岁，p = 0.02）。住院时间为0.9±0.5天，两组间相似（p = 0.24）。同时进行子宫切除术的手术时间更长（186.1±52.7分钟 vs 123.1±47.2分钟，p = 0.02）。术后24小时的VAS评分（子宫切除术组 = 3.0±2.3，未行子宫切除术组 = 2.7±2.3，p = 0.49）和MME（51.4±74.5 vs 37.1±60.4，p = 0.15）均相似。测量疼痛干扰的患者报告结局测量信息系统评分在两组间无差异（22.9±9.7 vs 20.9±9.3，p = 0.21，可能范围8 - 40）。线性回归显示，同时进行子宫切除术对术后24小时的VAS评分无影响（调整后β = 0.113；p = 0.77），对术后24小时的MME也无影响（调整后β = 14.25；p = 0.15）。
尽管同时进行子宫切除术的手术时间更长且患者更年轻，但在进行和未进行子宫切除术的POP手术中，术后24小时的VAS疼痛评分、术后24小时的MME阿片类药物使用量或其他疼痛指标并无差异。总体而言，阿片类药物的使用和疼痛评分较低。
