Post-operative experiences of patients undergoing laparoscopic gynaecological surgery at an academic training hospital

Abstract

Background: There is a global trend towards performing gynaecological surgery laparoscopically. The anaesthetic technique should complement the minimally invasive nature of the surgical technique. Developing an understanding of patients’ experiences following laparoscopic gynaecological surgery is the first step toward improving the anaesthetic technique utilised for these surgeries, thereby aiming to improve the patient’s peri-operative surgical experience. Method: We performed a retrospective descriptive study from 1 August 2014 to 31 December 2016 on all available PAIN OUT data for patients having undergone a laparoscopic gynaecological procedure at a university teaching hospital in South Africa. Data on pain experiences and side effects was captured. PAIN – OUT is an international pain database. The main focus of PAIN – OUT is to improve the management of post-operative pain. In order to facilitate the aim of PAIN – OUT, data about post-operative pain from medical facilities internationally was collected and pooled into one database. The database may provide feedback and benchmarking for staff in each centre about how patients are being managed especially with concern to pain patients may experience. The hope is that the information will help healthcare workers improve the management of pain for their patients. Results: Data representing 55% of cases for the period under review was available. The median age of all patients recruited to the study was 37 years old. All participants were of African descent. The median numerical rating scale (NRS) score for ‘worst’ and ‘least’ pain since surgery for all patients having undergone a laparoscopic gynaecological procedure was 5 and 3 respectively; the difference being statistically significant p<0.0001. Sixty percent of patients reported drowsiness, 48.2% of patients experienced nausea or vomiting and 22.7% of patients experienced pruritus. The median scores for drowsiness, nausea or vomiting and pruritus was 2, 0, 0 respectively. Conclusion: Although most patients experienced post – operative pain, and side effects experienced were higher than recommended standards of care, the severity of pain and side effects experienced may be said to be tolerable. Although side effects were noted, they were not statistically significant. The findings of this study do not clearly prove if the side effects were from opiates or not. Side effects experienced may be from opiates administered or from the surgical procedure itself.