Postoperative Pain Management Procedures in Laparoscopic Gynecological Surgery: A Systematic Review

Abstract

Rationale — Pain management (PM) is a critical parameter for achieving satisfactory surgical outcomes. Despite numerous studies on PM, no comprehensive study on postoperative PM in laparoscopic gynecological (LG) surgeries has been found. Consequently, the goal of this systematic review was to collect information on the procedures used for postoperative PM in invasive LG interventions. Methods — MeSH keywords (“postoperative”, “postoperation”, “postsurgery”, “pain management”, “pain control”, “analgesia”, “laparoscopy”, “gynaecology”, and “gynecology”) were identified for the systematic review in validated medical databases (WoS, PubMed, Scopus, ScienceDirect, and Embase). The collected articles were included in the primary and secondary screening according to the 2020 PRISMA guidelines. Articles of medium and high quality were finally selected based on the STROBE checklist, and the relevant articles were summarized and classified as a systematic review. Results — A total of 421 articles were found in the initial search. Then, after excluding duplicates (n=182), 108 and 80 irrelevant articles were also excluded (primary and secondary screening, respectively); 22 low-quality studies were also ignored. Hence, 29 relevant high-quality articles were selected for data extraction and synthesis. All applicable PM procedures in LG surgeries were categorized into four major approaches: pharmacological, non-pharmacological, psychological, and gas management methods. Conclusion — Since intraperitoneal organs are manipulated during LG surgeries, the use of intraperitoneal analgesia along with gas management and patient positioning are the main noninvasive pain management protocols.