[Postoperative pain relief after gynecologic surgery]

Abstract

Early administration of analgesics, generally before awakening from general anesthesia is useful to improve the patient's comfort in the post-anesthesia care unit (PACU). Multimodal analgesia includes administration of several analgesics from different pharmacological classes but in almost every combination, morphine or one of its derivatives is included. In the PACU, morphine is titrated using the intravenous route to obtain adequate and rapid pain relief. Analgesics are administered orally as soon as possible and in the vast majority of cases, immediate postoperative administration can be performed orally. After minor surgery (for example: diagnostic or operative laparoscopy) often performed in out-patients, a combination of acetaminophen and of a non-steroidal anti-inflammatory drug with or without an oral preparation of morphine is efficient and safe. Intraperitoneal administration of a local anesthetic can be a useful addition. When the postoperative surgical stress is expected to be of moderate intensity (for example: hysterectomy), the same combinations can be used but are initially administered intravenously. Nefopam, which is available only by intravenous administration in France, can be safely added. Morphine is often applied using a patient-controlled analgesia device (PCA). After major surgery (especially after radical surgery for malignant disease), intrathecal or epidural analgesia, using a local anesthetic and an opioid is extremely efficient and is combined with other analgesics. Finally, because the affective dimension is extremely important after gynecologic surgery (especially in mutilating interventions), psychologic preparation, patient information and communication are essential components of care.