Laparoscopically assisted vaginal and abdominal hysterectomy: comparison of postoperative pain fatigue and systemic response. A case-control study

Background and objective Laparoscopic and open. surgery have been compared with conflicting results regarding their systemic responses. The sensitivit y of biochemical markers that are used to discriminate between the stress r esponses to different types of surgery varies from study to study. We wante d to evaluate the stress response and the sensitivity of clinical and bioch emical stress markers in patients undergoing laparoscopically assisted vagi nal or abdominal hysterectomy. Methods We performed a case-control study with patients undergoing laparosc opically assisted vaginal hysterectomy (n = 20) or abdominal hysterectomy ( n = 20). Pain scores were assessed at rest and during coughing, and active leg elevation and fatigue scores using a visual analogue scale. In 10 patie nts of each group, haematocrit, white cell count, C-reactive protein, gluco se, cortisol, adrenocorticotrophic hormone, beta -endorphin immunoreactivit y, interleukin-6 and urine excretion of epinephrine and norepinephrine were measured preoperatively and during the first 44 postoperative hours. Results The most sensitive symptoms and markers of the systemic response we re pain scores during mobilization, fatigue scores, C-reactive protein and interleukin-6 (P < 0.01 in all comparisons). Pain scores at rest, and all o ther laboratory markers of the systemic response, did not discriminate betw een the two types of surgery. Conclusion Follow-up of postoperative pain scores during mobilization and f atigue levels might be an easy toot for the evaluation of postoperative rec overy. Using an identical anaesthetic technique, the neuroendocrine respons e was of the same magnitude after both types of surgery.