| Background and ObjectiveBased on evidence-based medicine basis for a series of perioperative optimization,make the patients achieve the goal of fast rehabilitation is ERAS(enhanced recovery aftersurgery)which accelerate rehabilitation surgery core idea.ERAS 'implementation is mainly to reduce stress and trauma,and optimize perioperative(preoperative,intraoperative and postoperative)management measures to accelerate the rapid postoperative recovery of patients,so as to shorten the hospital stay and reduce the burden of patients.The implementation of the ERAS program in the postoperative period plays an important role in optimizing the postoperative pain management.At present,most of the existing measures for postoperative pain management are postoperative analgesic pump.Although postoperative analgesic pump can alleviate the pain of patients to some extent,it also increases the incidence of postoperative adverse reactions such as nausea and vomiting.There is no unified guide for rapid rehabilitation of gynecology,and few reports and studies on postoperative pain in gynecology.Therefore,this study objectively analyzed the degree of postoperative pain,the application of postoperative analgesia pump and the occurrence of adverse reactions in common gynecological surgeries,so as to providea reference for the promotion of rapid recovery(ERAGS)after gynecological surgeries.MethodsFrom 1 May 2018 to 1 August 2018,560 cases ofcervical conization,624 cases of hysteroscopic surgery,432 cases of laparoscopic hysterectomy for benign uterine lesions,608 cases of laparoscopic excision of ovarian cysts or appendectomy for benign ovarian lesions.200 cases of radical operation for gynecologic malignant tumor in the first affiliated Hospital of Zhengzhou University were enrolled in the study.The observation parameters included the pain score on the first day after operation,Analgesic measures and adverse reactions.Pain score was assessed with VAS,NRS or Wong-Baker facial expression scale(0-3mild pain,4-6moderate pain,7-10 severe pain).analgesic adverse reactions included Nausea,vomiting,dizziness,lethargy,restlessness,respiratory inhibition and pruritus.ResultsThere were 214 cases(38.2%)were treated with analgesia pump and 347cases(61.8%)did not use analgesic pump among 560 casess after cervical conization.Compared with the latter,there was no significant decrease in pain score(1.70 1.75 vs 2.22 0.96,P=0.137),and the incidence of adverse reactions was significantly increased(44.9%vs4.6%,P=0.013).No other analgesic measures were taken in the patients without analgesic pump.There were 364 cases(58.3%)were treated with analgesia pump and 260cases(41.7%)did not use analgesic pump among 624 casess with hysteroscopy.Compared with the latter,there was no significant decrease in pain score(1.65 1.54 vs 1.72 1.86,P=0.063),and the incidence of adverse reactions was significantly increased(36.3%vs4.6%,P=0.027).No other analgesic measures were taken in the patients without analgesic pump.There were 304 cases(70.4%)were treated with analgesia pump and 128cases(29.6%)did not use analgesic pump among 432 casess with laparoscopichysterectomy.There was no significant difference in pain score between those who received analgesic pump and those who received no analgesic pump(3.860.64 vs 5.89 0.87,P=0.013).The incidence of adverse reactions to analgesic pump was significantly higher(40.8% vs 12.5%,P= 0.031).There were 392 cases(62.4%)were treated with analgesia pump and 236cases(37.6%)did not use analgesic pump among 608 casess with laparoscopic surgery for Excision of accessory cyst/adnexectomy.The degree of pain was significantly reduced(3.35 01.23 vs 5.51 1.02,P= 0.005)in those who applied analgesic pump and those who did not(3.35 1.23 vs 3.57 0.25,P=0.226).The incidence of adverse reactions with analgesic pump was significantly increased(26.3% vs.8.9%,P=0.016).There were 172 cases(86%)were treated with analgesia pump and 28cases(14%%)did not use analgesic pump among 200 casess with radical operation for gynecological malignant tumor.The degree of pain was significantly reduced(3.35 1.23 vs 7.68 1.53,P=0.007)in those who applied analgesic pump and those who did not(3.35 1.23 vs 6.74 1.54,P=0.011).The incidence of adverse reactions with analgesic pump was significantly increased(37.2% vs.21.4%,P=0.037).Conclusion1.The degree of pain after cervical conus resection and hysteroscopic surgery was mild and no analgesic measures were taken.2.Thepain degree after hysterectomy and adnexal cyst exfoliation/adnexectomy is moderate,and patients can use other analgesics(tramadol injection/flurbiprofen ester injection,etc.)to alleviate pain and reduce postoperative adverse reactions.3.The postoperative pain degree of malignant tumor radical resection is severe,and the application of analgesic pump can significantly reduce the pain,but special attention should be paid to the prevention and treatment of adverse reactions. |
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