Effect Of Menstrual Phase And Gonadal Hormones On Postoperative Pain In Gynecological Laparoscopic Surgery

Object:To investigate the correlation between the different menstrual phases and postoperative acute pain score, as well tramadol consumption in patients undergoing gynecological laparoscopic surgery.Methods:Ninety-two patients undergoing elective gynecological laparoscopic surgery were enrolled in this research, ASA â… -â…¡ grade, age18-45years old. According to the menstrual days (exclude menstrual period), all the patients were divided into F group (follicular phase, n=29), O group(ovulation phase, n=33) and L group(luteal phase, n=30). Menstrual cycle start point was determined by self-report of the first day of bleeding (cycle day1). Follicle phase was6-10th menstrual days, ovulation phase was13-17th menstrual days and luteal phase was21-25h menstrual days. Types of laparoscopic surgery included subtotal hysterectomy, myomectomy, ophorocystectomy and adnexectomy. Chronic pain, menopause, severe systemic disease, emergency surgery, body mass index greater than35, taking the hormone drugs in the recent two months and the patients with irregular menstrual cycle were excluded. The serum level of conventional sex hormones including follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and progesterone (P) were detected within preoperative24h. The tracheal intubation general anesthesia and carbon dioxide pneumoperitoneum were performed after fast intravenous induction. Pneumoperitoneum pressure was maintained at12-14mmHg. Prophylactic antiemetic was administrated at the end of surgery, however, without postoperative intraperitoneal drainage. All the patients were used intravenous analgesia by patient-controlled analgesia (PCA) with ramadol (800mg/100ml) within48h after surgery,2ml bolus and10min locking interval were settle. Postoperative pain was evaluated in24h and48h after operation using visual analogue pain scale (VAS). Meanwhile the consumption of tramadol PCA in0-24h and24-48h phases after operation were observed. Comparisons of postoperative VAS and tramadol consumption among the three groups were made by applying one-way analysis of variance (ANOVA), the correlations between hormone levels and VAS were computed by applying person regression in three menstrual phases, respectively.Results:1. No significant differences were observed among three groups in characteristics and demographic data.2. The postoperative24h VAS in O group was significant higher than them in F and L groups (p<0.05), Similarly, the PCA tramadol consumption in O group was significant higher than the other groups in0-24h after surgery phase(p<0.05). But the significant difference was not observed in postoperative48h among three groups (p>0.05).3. The postoperative48h VAS and the all hormones were not significantly correlated in three phases, whereas the postoperative24h VAS was significantly positively associated with serum E2levels in the O phase (r=0.75,p=0.02). Conclusion:The postoperative pain and analgesic consumption were significant higher in ovulation phase than in follicular phase and luteal phase within24h after gynecological laparoscopic surgery. Therefore we suggest that the postoperative anesthesia should be adopted with individual treatment according the menstrual phases.