Effectiveness of preemptive Gabapentin on postoperative pain after vaginal hysterectomy / 대한산부인과학회지

OBJECTIVE: Gabapentin is a new generation anticonvulsant drug. Preemptive gabapentin may produce analgesic effect in postoperative patient and have antiemetic effect. The aim of the present study was to investigate the opioid-sparing and analgesic effect of preemptive gabapentin on postoperative pain in patient undergoing vaginal hysterectomy. METHODS: In a randomized, double-blind, controlled study, 40 patients scheduled for an elective vaginal total hysterectomy were investigated/-. The patients were randomized to receive either oral gabapentin 1200mg (GABA group 2, n=17) or 900mg (GABA group 1, n=13) with premedication the night before and again 2hours before surgery. The other group (control group, n=10) had only routine premedication without gabapentin. All patients received patient-controlled analgesia (PCA). Postoperatively, pain was assessed using a visual analogue scale (VAS, 0-10) at time 1, 2, 4, 8, and 20 hours. Cumulative PCA consumption and opioid-related adverse events (nausea, vomiting, dizziness) was recorded. RESULTS: There was significant decrease of fentanly consumption in gabapentin group (GABA 2 group : 57.51+/-8.95 mg, GABA 1 group : 52.21+/-5.78 mg) compared to control group (50.63+/-2.55 mg)(p<0.05). There was no significant difference in side-effect (nausea, vomiting, dizziness) were observed between case and control group. CONCLUSIONS: Preemptive gabapentin has a good analgesic effect and reduce postoperative fentanyl consumption on postoperative pain after vaginal hysterectomy. Gabapentin effectively rescue analgesic requirement in post-operative patients with vaginal total hysterectomy.

The clinical studies on 600 cases of total laparoscopic hysterectomy (TLH) / 대한산부인과학회지

OBJECTIVE: To analyze the clinical characteristics of total laparoscopic hysterectomy. METHODS: Clinical data about 600 cases who received TLH were collected and the hospital stay, operation time and complication were evaluated. RESULTS: The most common indications for TLH were uterine myomas, adenomyosis, severe endometriosis and cervical intraepithelial neoplasia. Mean operating time was 90 minutes (range 35-200 min) and hospital stay was 3 days (range 2 days-10 days). The most important factors for the surgery time were uterine size, assistant's skill and presence of adhesions (obliteration of the cul-de-sac due to severe pelvic endometriosis). Several techniques were used, including bipolar coagulation of the ovarian and uterine vessels, and suture of the stump. A special uterine manipulator (RUMITM uterine manipulator with colpotomizer and pneumooccluder balloon) used in all procedures aided in anatomic definition and performing the circumferential colpotomy. We had two cases of ureteral obliteration by using bipolar coagulator, and 3 cases of bladder injuries during operation which was diagnosed and immediately repaired laparoscopically. We had two cases of ureterovaginal fistula, two cases of postoperative ileus and one case of bowel perforation. But there were no cases of death, thrombophlebitis or other pulmonary complications. CONCLUSIONS: Total laparoscopic hysterectomy can be performed safely and effectively when the surgical team is sufficiently trained. And we believe that total laparoscopic hysterectomy offers benefits to the patients in the form of less post-operative pain, shorter time in hospital.